Provider Demographics
NPI:1790882660
Name:BRANDRUP, PETER WARREN (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:WARREN
Last Name:BRANDRUP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 WILLOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-2903
Mailing Address - Country:US
Mailing Address - Phone:703-861-2149
Mailing Address - Fax:
Practice Address - Street 1:720 WILLOW GLEN DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922-2903
Practice Address - Country:US
Practice Address - Phone:703-861-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002831A207L00000X
TXM7871207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology