Provider Demographics
NPI:1508818378
Name:BRANNON, HORACE DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:HORACE
Middle Name:DAVID
Last Name:BRANNON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-0553
Mailing Address - Country:US
Mailing Address - Phone:850-476-0559
Mailing Address - Fax:
Practice Address - Street 1:2400 S HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-5808
Practice Address - Country:US
Practice Address - Phone:850-476-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53357207Q00000X
ALMD 20705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061544700Medicaid
FLE22600Medicare UPIN
FL061544700Medicaid