Provider Demographics
NPI:1760443212
Name:ARCHER, BRANCH T III (MD)
Entity Type:Individual
Prefix:
First Name:BRANCH
Middle Name:T
Last Name:ARCHER
Suffix:III
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:PO BOX 3780
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-3780
Mailing Address - Country:US
Mailing Address - Phone:806-355-3352
Mailing Address - Fax:
Practice Address - Street 1:1901 MEDI PARK
Practice Address - Street 2:STE 2050
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2110
Practice Address - Country:US
Practice Address - Phone:806-355-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ18482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
107648100OtherFIRSTCARE
TX132619103Medicaid
TXMDJ1848OtherWORKERS COMPENSATION
OK100151800AMedicaid
TX82R442OtherBLUE CROSS OF TEXAS
NMJ8598Medicaid
TX132619103Medicaid
OK100151800AMedicaid
G08192Medicare UPIN
300067401Medicare ID - Type UnspecifiedRAILROAD MEDICARE