Provider Demographics
NPI:1619979614
Name:ATKINSON, BRANDON S (DO)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:S
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12465 TIMBERLAND BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5215
Mailing Address - Country:US
Mailing Address - Phone:817-741-8355
Mailing Address - Fax:817-741-8365
Practice Address - Street 1:12465 TIMBERLAND BLVD STE 401
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5215
Practice Address - Country:US
Practice Address - Phone:817-741-8355
Practice Address - Fax:817-741-8365
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7613207Q00000X
TXN1538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204741701Medicaid
CA00AX76130Medicaid
H72093Medicare UPIN
CA00AX76130Medicaid
TX204741701Medicaid