Provider Demographics
NPI:1427637990
Name:FRANCIS, BRANDON VANCE (MED)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:VANCE
Last Name:FRANCIS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 W STERN DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5335
Mailing Address - Country:US
Mailing Address - Phone:801-243-4991
Mailing Address - Fax:
Practice Address - Street 1:1328 W STERN DR
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5335
Practice Address - Country:US
Practice Address - Phone:801-243-4991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X
UT0454252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT411557OtherCACTUS