| Brad A. Brazeal Md Pa | |
|
300 Willow Creek Pkwy Ste 210 Palestine TX 75801-4421 | |
| (903) 723-1940 | |
| (903) 723-8307 |
| Full Name | Brad A. Brazeal Md Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 300 Willow Creek Pkwy, Palestine, Texas |
| Authorized Official Name and Position | Brad A Brazeal (SELF/OWNER) |
| Authorized Official Contact | 9037231940 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brad A. Brazeal Md Pa 300 Willow Creek Pkwy Ste 210 Palestine TX 75801-4421 Ph: (903) 723-1940 | Brad A. Brazeal Md Pa 300 Willow Creek Pkwy Ste 210 Palestine TX 75801-4421 Ph: (903) 723-1940 |
| NPI Number | 1821283441 |
|---|---|
| Provider Enumeration Date | 09/06/2007 |
| Last Update Date | 02/01/2016 |
| Medicare PECOS PAC ID | 8628049707 |
|---|---|
| Medicare Enrollment ID | O20040803000698 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821283441 | NPI | - | NPPES |
| 166535801 | Medicaid | TX | |
| 124200005 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 50509 (Texas) | Primary |
| 2084P2900X | Psychiatry & Neurology - Pain Medicine | 50509 (Texas) | Secondary |
| Provider Name | Brad A Brazeal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265415640 PECOS PAC ID: 3870564958 Enrollment ID: I20040804001215 |
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