Provider Demographics
NPI:1528279189
Name:MINER, BRANDON LYNN (DO)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LYNN
Last Name:MINER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2085 PROVIDENCE WAY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4945
Mailing Address - Country:US
Mailing Address - Phone:208-525-4888
Mailing Address - Fax:208-525-4885
Practice Address - Street 1:2085 PROVIDENCE WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4945
Practice Address - Country:US
Practice Address - Phone:208-525-4888
Practice Address - Fax:208-525-4885
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDO-0568207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery