Active NPI
Gilbert Theodore Brandon, MD
- Otolaryngology Physician
- Clarksville, TN
National Provider Identifier
1811987050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 14164
- Practice address
- 1740 Memorial Dr
Clarksville, TN 37043-4561 - Phone
- (931) 245-8700
- Fax
- (931) 245-8747
- NPI assigned
- Oct 27, 2005
- Last updated
- May 3, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 14164 | TN | Primary |
Addresses
Primary practice location
1740 Memorial Dr
Clarksville, TN 37043-4561
Mailing address
PO Box 3799
Dept a
Clarksville, TN 37043-3799
Phone (931) 245-8700
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3032426 | Medicaid | TN | |
| 040008556 | Other | TN | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14164 | TN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367539200000",
"number": "1811987050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3799",
"address_2": "DEPT A",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370433799",
"telephone_number": "931-245-8700",
"fax_number": "931-245-8747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1740 MEMORIAL DR",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370434561",
"telephone_number": "931-245-8700",
"fax_number": "931-245-8747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANDON",
"first_name": "GILBERT",
"middle_name": "THEODORE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-27",
"last_updated": "2013-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "TN",
"license": "14164",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3032426",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "040008556",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.