Provider Demographics
NPI:1205802261
Name:BRAND, JEFFERSON CARTER JR (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFERSON
Middle Name:CARTER
Last Name:BRAND
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:111 17TH AVE E STE 101
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-3734
Mailing Address - Country:US
Mailing Address - Phone:320-762-1144
Mailing Address - Fax:320-762-1935
Practice Address - Street 1:111 17TH AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-5273
Practice Address - Country:US
Practice Address - Phone:320-762-1144
Practice Address - Fax:320-762-1935
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2024-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN31250207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1205802261Medicaid
MN1205802261Medicaid
MN200003127Medicare PIN
BB1217252OtherDEA