Basic Information
| Provider Information | |||||||||
| NPI: | 1285017947 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAND | ||||||||
| FirstName: | TYRONE | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DIXON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610213116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152858520 | ||||||||
| FaxNumber: | 8152858903 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DIXON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152855629 | ||||||||
| FaxNumber: | 8152855634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2015 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036145130 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 036145130 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207P00000X | 036145130 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.