Provider Demographics
NPI:1578722195
Name:BRAKHAGE, CHARLES H (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:H
Last Name:BRAKHAGE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E SONTERRA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3993
Mailing Address - Country:US
Mailing Address - Phone:210-496-7999
Mailing Address - Fax:210-494-1666
Practice Address - Street 1:225 E SONTERRA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3993
Practice Address - Country:US
Practice Address - Phone:210-496-7999
Practice Address - Fax:210-494-1666
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01399363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical