Individual
GENE D BRANUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
180 1ST ST W, #301, KETCHUM, ID 83340
(208) 726-3707
Mailing address
PO BOX 3778, KETCHUM, ID 83340-3721
(208) 726-3707
(208) 726-4817
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
0101230423
VA
208600000X
Surgery Physician
Primary
M-13897
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1386640076
BLUE CROSS OF ID
ID
05
—
1386640076
—
ID
Enumeration date
06/27/2005
Last updated
06/08/2020
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