Provider Demographics
NPI:1447273321
Name:BRANTLEY, RICK SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:SCOTT
Last Name:BRANTLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1566 OTTERCREEK DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-2856
Mailing Address - Country:US
Mailing Address - Phone:513-831-5955
Mailing Address - Fax:
Practice Address - Street 1:935 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1911
Practice Address - Country:US
Practice Address - Phone:513-831-5955
Practice Address - Fax:513-831-5985
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067467B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBR0770865Medicare PIN
OHF91431Medicare UPIN
OHBR0770866Medicare PIN
OHBR0770864Medicare PIN
OHBR0770862Medicare PIN
OHBR0770863Medicare PIN
OHBR0770861Medicare PIN