Provider Demographics
NPI:1750143715
Name:ELLIOT, BRANDON LEE (ACS, RDCS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:ELLIOT
Suffix:
Gender:M
Credentials:ACS, RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 PRINE LN
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-2030
Mailing Address - Country:US
Mailing Address - Phone:832-423-8808
Mailing Address - Fax:
Practice Address - Street 1:3901 PRINE LN
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-2030
Practice Address - Country:US
Practice Address - Phone:832-423-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00099090246XS1301X
TX124828246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography