Individual
DR. E JON BRANDENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1818 CAREW ST STE 120, FORT WAYNE, IN 46805-4764
(260) 425-6200
(260) 425-6205
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01028550A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000595565
ANTHEM
IN
05
—
100369280A
—
IN
01
—
P00698403
RAILROAD MEDICARE
IN
Enumeration date
08/20/2006
Last updated
10/07/2022
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