Basic Information
| Provider Information | |||||||||
| NPI: | 1689664674 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANCH | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 DODSON AVE | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374063214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237782800 | ||||||||
| FaxNumber: | 4237782806 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 DODSON AVE | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374063214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237782800 | ||||||||
| FaxNumber: | 4237782806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 11/18/2013 | ||||||||
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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 | 207V00000X | 1719 | TN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 35067 | 01 | TN | TLC | OTHER | 626001636 | 01 | TN | USA MANAGED CARE | OTHER | 3319387 | 05 | TN | MEDICAID | 5093020 | 01 | TN | CIGNA | OTHER | 626001636 | 01 | TN | UNITED HEALTHCARE | OTHER | 4107725 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 626001636 | 01 | TN | HEALTH PARTNERS | OTHER |