Provider Demographics
NPI:1841245552
Name:HAMISCH, BRANDON TARL (DO)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:TARL
Last Name:HAMISCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:5802 SARATOGA BLVD STE 130
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4252
Practice Address - Country:US
Practice Address - Phone:361-696-6200
Practice Address - Fax:361-985-0305
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP02601747OtherMCRR
TX167840106Medicaid
TX167840108Medicaid
TX130864507Medicaid
TX1L5691OtherMEDICARE