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Individual

DR. DANIEL TODD BRANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
1 MEDICAL VILLAGE DR, SUITE 258, EDGEWOOD, KY 41017-3403
(859) 301-2211
Mailing address
20 MEDICAL VILLAGE DR, SUITE 258, EDGEWOOD, KY 41017-5401
(859) 301-2211

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
03376
KY
207L00000X
Anesthesiology Physician
Primary
2009018186
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000720844
ANTHEM BLUE SHIELD
OH
05
0062255
OH
05
201042850
IN
01
40531238600
BUREAU OF WORKERS COMPENSATION
OH
05
7100173380
KY
Enumeration date
12/17/2010
Last updated
06/12/2012
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