Individual
JEFFERY T BRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
800 GRAND CENTRAL MALL, SUITE 4, VIENNA, WV 26105-4131
(304) 485-3300
(304) 485-3317
Mailing address
800 GRAND CENTRAL MALL, SUITE 4, VIENNA, WV 26105-4131
(304) 485-3300
(304) 485-3317
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1492
WV
207Q00000X
Family Medicine Physician
34.008763
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0046514000
—
WV
Enumeration date
05/24/2005
Last updated
09/15/2022
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