Provider Demographics
NPI:1053096230
Name:PERSONS, BRANDON TYLER
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:TYLER
Last Name:PERSONS
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 1:5380 E 132ND ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-3206
Mailing Address - Country:US
Mailing Address - Phone:216-633-9833
Mailing Address - Fax:
Practice Address - Street 1:5380 E 132ND ST
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3206
Practice Address - Country:US
Practice Address - Phone:216-633-9833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTF228950347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker