Provider Demographics
NPI:1346413358
Name:TILLEY, BRANDON KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:KEITH
Last Name:TILLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-0387
Mailing Address - Country:US
Mailing Address - Phone:225-635-3269
Mailing Address - Fax:855-392-3007
Practice Address - Street 1:5266 COMMERCE ST BLDG A
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-4409
Practice Address - Country:US
Practice Address - Phone:225-635-3269
Practice Address - Fax:855-392-3007
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA205178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine