Provider Demographics
NPI:1588834683
Name:BRANDON, ANTHONY LOUIS (ETC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:LOUIS
Last Name:BRANDON
Suffix:
Gender:M
Credentials:ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:323 E CLINTON PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6455
Mailing Address - Country:US
Mailing Address - Phone:314-565-0560
Mailing Address - Fax:314-822-4612
Practice Address - Street 1:323 E CLINTON PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6455
Practice Address - Country:US
Practice Address - Phone:314-565-0560
Practice Address - Fax:314-822-4612
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)