Provider Demographics
NPI:1760441273
Name:MADSON, BRANDON E (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:E
Last Name:MADSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-1901
Mailing Address - Country:US
Mailing Address - Phone:515-262-0404
Mailing Address - Fax:515-262-0489
Practice Address - Street 1:2301 E 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-1901
Practice Address - Country:US
Practice Address - Phone:515-262-0404
Practice Address - Fax:515-262-0489
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-32653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1154260Medicaid
IA1760441273Medicaid
IA1760441273Medicaid
IA080164919Medicare PIN
G58498Medicare UPIN
IA18580Medicare PIN