Provider Demographics
NPI:1003010703
Name:BRINDLEY, MACE BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MACE
Middle Name:BENJAMIN
Last Name:BRINDLEY
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 1:601 W HWY 6 STE 106
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5592
Mailing Address - Country:US
Mailing Address - Phone:254-776-7744
Mailing Address - Fax:254-751-9211
Practice Address - Street 1:601 W HWY 6 STE 106
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5592
Practice Address - Country:US
Practice Address - Phone:254-776-7744
Practice Address - Fax:254-751-9211
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8557207YP0228X, 207YS0012X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003010703Medicare PIN