Individual
JACK W BRAND JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1720A MEDICAL PARK DR, SUITE 340, BILOXI, MS 39532-2129
(228) 392-7429
(228) 396-3830
Mailing address
1720A MEDICAL PARK DR, SUITE 340, BILOXI, MS 39532-2129
(228) 392-7429
(228) 396-3830
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
10246
MS
207RC0000X
Cardiovascular Disease Physician
11555
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05025093
—
MS
01
—
1194874222
GROUP NPI
MS
01
—
C02478
GROUP MEDICARE
—
Enumeration date
06/08/2005
Last updated
07/19/2012
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