Provider Demographics
NPI:1710548680
Name:REID, BRANDON ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:ROBERT
Last Name:REID
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 1:3515 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4921
Mailing Address - Country:US
Mailing Address - Phone:316-755-0144
Mailing Address - Fax:844-274-1204
Practice Address - Street 1:929 N ST FRANCIS ST FL TOWER6
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-261-8303
Practice Address - Fax:844-274-1204
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-48269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty