Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 12535 | TX |
N | 111NN1001X | Nutrition | 12535 | TX |
N | 111NS0005X | Chiropractic Sports Physician | 12535 | TX |
NPI | 1952728545 |
---|---|
Provider Name | Dr. Brandon Nutt |
First Address | Dallas, TX 75230-1253 |
Second Address | Dallas, TX 75225-3452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2014 |
Last Update Date | 21/03/2014 |