Provider Demographics
NPI:1174772131
Name:BRANSON, DAVID LESLIE
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LESLIE
Last Name:BRANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 W 46TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-2804
Mailing Address - Country:US
Mailing Address - Phone:316-832-0056
Mailing Address - Fax:316-832-0056
Practice Address - Street 1:812 W 46TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67204-2804
Practice Address - Country:US
Practice Address - Phone:316-832-0056
Practice Address - Fax:316-832-0056
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS26-3352078OtherEMPLOYER IDENTIFICATION NUMBER-IRS