Individual
GARY S BRANUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
975 E THIRD ST, CHATTANOOGA, TN 37403-2147
(423) 778-7806
(423) 778-2360
Mailing address
PO BOX 11225, CHATTANOOGA, TN 37401-2225
(423) 892-5602
(423) 892-5838
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN65030
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
APN11063
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009932774
—
AL
05
—
3601670
—
TN
01
—
4102567
BLUE CROSS BLUE SHIELD TN
TN
05
—
8052303
—
NC
05
—
879916758B
—
GA
01
—
P00252614
RAILROAD MEDICARE
TN
Enumeration date
01/29/2007
Last updated
01/20/2010
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