Individual
KADALLAH ZIZWEE BRANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
516 EAST NIZHONI BLVD., GALLUP, NM 87301-1337
(505) 722-1000
(505) 726-8557
Mailing address
P.O. BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
(505) 726-8557
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
46860
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VAD000
FEDERAL UPIN
TN
Enumeration date
07/22/2008
Last updated
08/15/2011
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