Provider Demographics
NPI:1013282375
Name:ALTILLO, BRANDON SHAUN ALLPORT (MD, MPH)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:SHAUN ALLPORT
Last Name:ALTILLO
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:BRANDON
Other - Middle Name:SHAUN
Other - Last Name:ALLPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 MONTOPOLIS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-6411
Mailing Address - Country:US
Mailing Address - Phone:512-978-9901
Mailing Address - Fax:512-901-9765
Practice Address - Street 1:2901 MONTOPOLIS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-6411
Practice Address - Country:US
Practice Address - Phone:512-978-9901
Practice Address - Fax:512-901-9765
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7644208000000X, 207R00000X
MDD81065208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist