Individual
GILBERT THEODORE BRANDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1740 MEMORIAL DR, CLARKSVILLE, TN 37043-4561
(931) 245-8700
(931) 245-8747
Mailing address
PO BOX 3799, DEPT A, CLARKSVILLE, TN 37043-3799
(931) 245-8700
(931) 245-8747
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
14164
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040008556
RR MEDICARE
TN
05
—
3032426
—
TN
Enumeration date
10/27/2005
Last updated
05/03/2013
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