Individual
BRANDON R. GUMBINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
215 E 1ST ST STE 310, DIXON, IL 61021
(815) 285-5801
(815) 285-5699
Mailing address
215 E 1ST ST STE 310, DIXON, IL 61021-3190
(815) 285-5801
(815) 285-5699
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
07001081
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016005377
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016005377
—
IL
01
—
508770006
MEDICARE
IN
01
—
F400482004
MEDICARE PTAN
IL
Enumeration date
06/30/2008
Last updated
11/12/2024
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