Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 35089639 | OH |
NPI | 1013114693 |
---|---|
Provider Name | Dr. Brannon Charles Duncan |
First Address | Kalamazoo, MI 49008-4801 |
Second Address | Kalamazoo, MI 49008-4801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 09/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0C910950 | BCBSM (01) | MI |
1013114693 | (05) | MI |