Provider Demographics
NPI:1043269491
Name:BRACKETT, BESS E (MD)
Entity Type:Individual
Prefix:DR
First Name:BESS
Middle Name:E
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1381
Mailing Address - Country:US
Mailing Address - Phone:802-728-2455
Mailing Address - Fax:802-728-2613
Practice Address - Street 1:44 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1381
Practice Address - Country:US
Practice Address - Phone:802-728-2455
Practice Address - Fax:802-728-2613
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38270207X00000X
VT042-0011811207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1016609Medicaid
VT001187701Medicare PIN
4595660001Medicare NSC
VT1016609Medicaid
COC449368Medicare PIN