Individual
KYLE BRANDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2294
(817) 321-0404
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3194
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101271354
VA
2085R0202X
Diagnostic Radiology Physician
Primary
V3563
TX
208D00000X
General Practice Physician
0101271354
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/18/2019
Last updated
12/30/2024
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