Provider Demographics
NPI:1578626263
Name:BRANNAN, STEVEN GARY (CRNA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:GARY
Last Name:BRANNAN
Suffix:
Gender:M
Credentials:CRNA
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 457
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-0457
Mailing Address - Country:US
Mailing Address - Phone:469-271-3663
Mailing Address - Fax:
Practice Address - Street 1:110 ANDERSON CR 406
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75803
Practice Address - Country:US
Practice Address - Phone:469-271-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX560360367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84197UOtherBCBS
TX130140008Medicaid