Provider Demographics
NPI:1811070006
Name:BRANDT, DANIEL J (MD, PC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:BRANDT
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
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Mailing Address - Street 1:424 N MESILLA ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2566
Mailing Address - Country:US
Mailing Address - Phone:505-525-8250
Mailing Address - Fax:505-647-2543
Practice Address - Street 1:424 N MESILLA ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2566
Practice Address - Country:US
Practice Address - Phone:505-525-8250
Practice Address - Fax:505-647-2543
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMNM91-102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry