Provider Demographics
NPI:1518227180
Name:SUR, BRANDON WOO RAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:WOO RAM
Last Name:SUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1272 PERCHERON PASS
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2793
Mailing Address - Country:US
Mailing Address - Phone:949-527-5863
Mailing Address - Fax:
Practice Address - Street 1:16 DEGRANDPRE WAY STE 600
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6454
Practice Address - Country:US
Practice Address - Phone:518-563-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN629872085R0204X
NY2729862085R0202X
MO20220420562085R0202X
PAMD4783042085R0202X
CAA1566342085R0202X
IL0361588352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology