Provider Demographics
NPI:1821142530
Name:ANTHONY J BRANZ MD PC
Entity Type:Organization
Organization Name:ANTHONY J BRANZ MD PC
Other - Org Name:OSBURN FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRANZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-556-4803
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:801 E MULLAN AVE
Mailing Address - City:OSBURN
Mailing Address - State:ID
Mailing Address - Zip Code:83849-0707
Mailing Address - Country:US
Mailing Address - Phone:208-556-4803
Mailing Address - Fax:208-556-1023
Practice Address - Street 1:801 E MULLAN AVENUE
Practice Address - Street 2:
Practice Address - City:OSBURN
Practice Address - State:ID
Practice Address - Zip Code:83849-0707
Practice Address - Country:US
Practice Address - Phone:208-556-4803
Practice Address - Fax:208-556-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-6860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1377737Medicare ID - Type UnspecifiedMEDICARE