Provider Demographics
NPI:1285626861
Name:BRESLAU, NEIL A (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:A
Last Name:BRESLAU
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 1:910 N CENTRAL EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5735
Mailing Address - Country:US
Mailing Address - Phone:214-823-6435
Mailing Address - Fax:214-823-4675
Practice Address - Street 1:910 N CENTRAL EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5735
Practice Address - Country:US
Practice Address - Phone:214-823-6435
Practice Address - Fax:214-823-4675
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2564174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1101175OtherUNITED
TX15857294OtherPACIFICARE
TX460002676OtherRAILROAD MEDICARE
TX3259878001OtherCIGNA
TX127604001Medicaid
TX4480002OtherAETNA
TX4480002OtherAETNA
TX127604001Medicaid