Provider Demographics
NPI:1902848047
Name:BRANSON, DENIS F (MD)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:F
Last Name:BRANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7000 E GENESEE ST
Mailing Address - Street 2:BUILDING E
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1131
Mailing Address - Country:US
Mailing Address - Phone:315-446-8313
Mailing Address - Fax:315-446-5387
Practice Address - Street 1:7000 E GENESEE ST
Practice Address - Street 2:BUILDING E
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1131
Practice Address - Country:US
Practice Address - Phone:315-446-8313
Practice Address - Fax:315-446-5387
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162343208200000X, 2082S0099X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070001967OtherPALMETTO GBA MEDICARE PR
NY161288118OtherTAX ID
NY50469BMedicare ID - Type Unspecified
NYB82826Medicare UPIN