Provider Demographics
NPI:1699520742
Name:WELBORN, BRANDON LEE SPEAKS (DO)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE SPEAKS
Last Name:WELBORN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MANNING DRIVE
Mailing Address - Street 2:CB# 7025, HOUPT PHYSICIAN OFFICE BUILDING
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-4221
Mailing Address - Country:US
Mailing Address - Phone:984-974-4401
Mailing Address - Fax:984-974-2285
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4226
Practice Address - Country:US
Practice Address - Phone:984-974-4401
Practice Address - Fax:984-974-2285
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCWELB-BYIF2K390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program