Provider Demographics
NPI:1447424007
Name:BRABHAM, DAVID GREGORY (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GREGORY
Last Name:BRABHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 I-40 W
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2512
Mailing Address - Country:US
Mailing Address - Phone:806-354-9764
Mailing Address - Fax:806-355-2728
Practice Address - Street 1:6200 I-40 W
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2512
Practice Address - Country:US
Practice Address - Phone:806-354-9764
Practice Address - Fax:806-355-2728
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7869207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM7869OtherTX LICENSE