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Individual

BRANDON RUSSELL ALLEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3003
(352) 265-5911
Mailing address
PO BOX 918025, ORLANDO, FL 32891-8025
(352) 265-5911

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME115055
FL
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
008989100
FL
Enumeration date
06/18/2010
Last updated
07/22/2013
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