Provider Demographics
NPI:1154347532
Name:GARY S BRANFMAN, MD,PA
Entity type:Organization
Organization Name:GARY S BRANFMAN, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-579-0315
Mailing Address - Street 1:110 MEDICAL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3101
Mailing Address - Country:US
Mailing Address - Phone:361-572-9833
Mailing Address - Fax:
Practice Address - Street 1:110 MEDICAL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3101
Practice Address - Country:US
Practice Address - Phone:361-572-9833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0045PWOtherBLUE CROSS
TX00G03UMedicare PIN