Individual
JOHN W BRAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5660
(601) 268-5759
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5660
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
11007
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00016196
—
MS
05
—
009936790
—
AL
01
—
020011281
RAILROAD MEDICARE
—
01
—
1558920
AMERICAN ADMIN GROUP
MS
Enumeration date
07/28/2006
Last updated
07/08/2020
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