Provider Demographics
NPI:1700977170
Name:BRANZ, ANTHONY J (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:BRANZ
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 707
Mailing Address - Street 2:
Mailing Address - City:OSBURN
Mailing Address - State:ID
Mailing Address - Zip Code:83849-0707
Mailing Address - Country:US
Mailing Address - Phone:208-556-4803
Mailing Address - Fax:208-556-1023
Practice Address - Street 1:801 E MULLAN AVENUE
Practice Address - Street 2:
Practice Address - City:OSBURN
Practice Address - State:ID
Practice Address - Zip Code:83849-0707
Practice Address - Country:US
Practice Address - Phone:208-556-4803
Practice Address - Fax:208-556-1023
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-6860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010001698OtherREGENCE BLUE SHIELD OF ID
ID39180OtherBLUE CROSS OF IDAHO
IDG-20015Medicare UPIN
ID39180OtherBLUE CROSS OF IDAHO