Provider Demographics
NPI:1811998248
Name:BRANT, ADAM (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BRANT
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 1:7130 N SHARON AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3386
Mailing Address - Country:US
Mailing Address - Phone:559-449-1100
Mailing Address - Fax:559-449-1863
Practice Address - Street 1:7130 N SHARON AVE
Practice Address - Street 2:STE 100
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3386
Practice Address - Country:US
Practice Address - Phone:559-449-1100
Practice Address - Fax:559-449-1863
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60203207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH58247Medicare UPIN
CA00A602030Medicare ID - Type Unspecified