Provider Demographics
NPI:1396240024
Name:BRANDT, MADISON PUMPHREY (MD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:PUMPHREY
Last Name:BRANDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:ELIZABETH
Other - Last Name:PUMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:653-1 W 8TH ST # L17
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-383-1037
Mailing Address - Fax:904-244-4059
Practice Address - Street 1:653-1 W 8TH ST # L17
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-383-1037
Practice Address - Fax:904-244-4059
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program