Provider Demographics
NPI:1740272467
Name:BRANDON, DONALD MILAN (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:MILAN
Last Name:BRANDON
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 1:2800 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6204
Mailing Address - Country:US
Mailing Address - Phone:619-291-2321
Mailing Address - Fax:619-294-3429
Practice Address - Street 1:2800 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6204
Practice Address - Country:US
Practice Address - Phone:619-291-2321
Practice Address - Fax:619-294-3429
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG071000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF03103Medicare UPIN
CAWG71000AMedicare PIN