Provider Demographics
NPI:1073563508
Name:BRANNAN, JOHN P JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:BRANNAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-471-7150
Practice Address - Fax:251-471-7008
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL56252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51526672OtherBCBS FILLINGIM
MS05400325Medicaid
AL51526628OtherBCBS
FL372781500Medicaid
AL009984055Medicaid
AL16-01238OtherUNITED HEALTHCARE
LA1163112Medicaid
AL009984045Medicaid
AL51526744OtherBCBS SRC
AL009984045Medicaid
AL16-01238OtherUNITED HEALTHCARE
ALP00244749Medicare ID - Type UnspecifiedPGBA RAILROAD
AL51526744OtherBCBS SRC