Provider Demographics
NPI:1801833645
Name:ISAACS, BRANDON G (DO)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:G
Last Name:ISAACS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 190930
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0930
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:6051 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8969
Practice Address - Country:US
Practice Address - Phone:208-302-7600
Practice Address - Fax:208-302-7605
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY6998A207Q00000X
WAOP60518627207Q00000X
ORDO-162239207Q00000X
IDO-303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1199099-00Medicaid
WA0344673OtherLABOR AND INDUSTRIES
WA2043374Medicaid