Provider Demographics
NPI:1336282664
Name:BRACHETTA, GUILLERMO EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:EDUARDO
Last Name:BRACHETTA
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 1:2300 MICHIGAN AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701
Mailing Address - Country:US
Mailing Address - Phone:432-687-0181
Mailing Address - Fax:432-687-1003
Practice Address - Street 1:2300 MICHIGAN AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-687-0181
Practice Address - Fax:432-687-1003
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5845208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000ME39Medicare ID - Type Unspecified
B21445Medicare UPIN