Provider Demographics
NPI:1013335082
Name:ANDERSON, BRANDON JAMAL (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JAMAL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:480-981-1326
Mailing Address - Fax:480-981-1445
Practice Address - Street 1:6111 E ARBOR AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6059
Practice Address - Country:US
Practice Address - Phone:480-981-1326
Practice Address - Fax:480-981-1445
Is Sole Proprietor?:No
Enumeration Date:2014-04-06
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ66244208600000X
CAA171538208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ125496Medicaid