Brad a. Brazeal MD PA
Organization Active NPI Psychiatry Physician · Palestine, TX
NPI 1821283441 · NPPES record last updated Feb 1, 2016
Key facts
- NPI
- 1821283441
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 50509 (TX)
- Legal business name
- BRAD A. BRAZEAL MD PA
- Practice address
- 300 Willow Creek Pkwy
Ste 210
Palestine, TX 75801-4421 - Phone
- (903) 723-1940
- Fax
- (903) 723-8307
- NPI assigned
- Sep 6, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Brad A Brazeal, MD
- Title
- Self/Owner
- Phone
- (903) 723-1940
Practitioners 1
-
Brad A Brazeal, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040803000698 | TX | Part B Supplier - Clinic/Group Practice | 8628049707 |
Receives reassigned benefits from 1 practitioner Practice locations: Palestine, TX |
National Provider Directory
Locations
126 Medical Dr
Ste A
Palestine, TX 75801
Phone (903) 723-1940
300 Willow Creek Pkwy
Ste 210
Palestine, TX 75801
Phone (903) 723-1940
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | 50509 | TX | Yes |
| Pain Medicine (Psychiatry & Neurology) Physician |
2084P2900X | 50509 | TX |
Addresses
Primary practice location
300 Willow Creek Pkwy
Ste 210
Palestine, TX 75801-4421
Mailing address
300 Willow Creek Pkwy
Ste 210
Palestine, TX 75801-4421
Phone (903) 723-1940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 166535801 | Medicaid | TX | |
| 124200005 | Medicaid | TX |
Other names
- Brad A. Brazeal MD PA
Other providers in Palestine, TX
- Blessed Beginnings Birth Center
- Bolton Healthcare, LLC
- Heather Elizabeth Boone
- Danny Lee Bowman
- Irma Campos Boyle
- Brandy Ricard, MD PA
- Steven Gary Brannan
- Brad A Brazeal
- Bridges to Health Non-Emergency Medical Transportation
- Amanda Renea Britton
All providers in Palestine, TX · Psychiatry Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.