Provider Demographics
NPI:1821741448
Name:BIRDOW, BRANDON L
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:L
Last Name:BIRDOW
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 1:5239 EISENHAUER RD APT 811
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3707
Mailing Address - Country:US
Mailing Address - Phone:210-580-4002
Mailing Address - Fax:
Practice Address - Street 1:5239 EISENHAUER RD APT 811
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3707
Practice Address - Country:US
Practice Address - Phone:210-580-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory