Provider Demographics
NPI:1356399950
Name:BRANTLEY, ROMAN RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:RUSSELL
Last Name:BRANTLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1770 INDEPENDENCE CT
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1259
Mailing Address - Country:US
Mailing Address - Phone:205-226-5900
Mailing Address - Fax:205-226-5937
Practice Address - Street 1:1088 9TH AVE SW STE 108
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-7833
Practice Address - Country:US
Practice Address - Phone:205-226-5900
Practice Address - Fax:205-226-5937
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2025-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL16517207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000034364Medicaid
AL000034364Medicaid
F28096Medicare UPIN