Provider Demographics
NPI:1265792022
Name:COMETTI, BRANDON C (MD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:C
Last Name:COMETTI
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 1:400 N PENNSYLVANIA AVE STE 920
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4779
Mailing Address - Country:US
Mailing Address - Phone:575-208-2509
Mailing Address - Fax:575-265-1700
Practice Address - Street 1:400 N PENNSYLVANIA AVE STE 920
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4779
Practice Address - Country:US
Practice Address - Phone:480-447-3579
Practice Address - Fax:575-265-1700
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2015-0095207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine