Provider Demographics
NPI:1104935071
Name:MCLAUGHLIN, BRANDON LEE (PA)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:LEE
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-2123
Mailing Address - Country:US
Mailing Address - Phone:308-946-3845
Mailing Address - Fax:308-946-2357
Practice Address - Street 1:2510 18TH AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826
Practice Address - Country:US
Practice Address - Phone:308-946-3845
Practice Address - Fax:308-946-2357
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1237207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37871OtherBLUECROSS & BLUESHIELD
P00295047OtherRAILROAD MEDICARE
Q62469Medicare UPIN
P00295047OtherRAILROAD MEDICARE