Provider Demographics
NPI:1417165002
Name:MICHENER, BRENT D (DO)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:D
Last Name:MICHENER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3270 JOE BATTLE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2639
Mailing Address - Country:US
Mailing Address - Phone:915-855-2400
Mailing Address - Fax:915-855-2401
Practice Address - Street 1:3270 JOE BATTLE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2639
Practice Address - Country:US
Practice Address - Phone:915-855-2400
Practice Address - Fax:915-855-2401
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2013-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM7798208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM7798OtherTEXAS MEDICAL LICENSE