Provider Demographics
NPI:1790745263
Name:BRANDLE, WARREN FRANK (MD)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:FRANK
Last Name:BRANDLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11226 GOLD EXPRESS DRIVE
Mailing Address - Street 2:#205
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4411
Mailing Address - Country:US
Mailing Address - Phone:916-638-2800
Mailing Address - Fax:916-382-2830
Practice Address - Street 1:11226 GOLD EXPRESS DR
Practice Address - Street 2:#205
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4411
Practice Address - Country:US
Practice Address - Phone:916-638-2800
Practice Address - Fax:916-638-2830
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2011-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA658031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A53369Medicare UPIN
CA658031Medicare ID - Type Unspecified