Provider Demographics
NPI:1295304368
Name:MAXWELL, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MAXWELL
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 1:1201 ALHAMBRA BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5242
Mailing Address - Country:US
Mailing Address - Phone:916-451-4400
Mailing Address - Fax:
Practice Address - Street 1:2030 SUTTER PL STE 2000
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6216
Practice Address - Country:US
Practice Address - Phone:916-451-4400
Practice Address - Fax:916-731-7955
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTL7279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine