Provider Demographics
NPI:1184474355
Name:MUNCAN, BRANDON MICHAEL
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:MICHAEL
Last Name:MUNCAN
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 1:10310 LAKE VISTA CT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4139
Mailing Address - Country:US
Mailing Address - Phone:917-586-3385
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2295
Practice Address - Country:US
Practice Address - Phone:650-723-6661
Practice Address - Fax:650-498-6205
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program