Provider Demographics
NPI:1780013862
Name:PEFFER, BRANDON
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:PEFFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-1120
Mailing Address - Country:US
Mailing Address - Phone:615-495-9921
Mailing Address - Fax:
Practice Address - Street 1:2410 PATTERSON ST
Practice Address - Street 2:SUITE 212
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1551
Practice Address - Country:US
Practice Address - Phone:615-342-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2438363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant