Provider Demographics
NPI:1609168855
Name:BRACKMAN, MARRI KAJFEZ (DO)
Entity Type:Individual
Prefix:
First Name:MARRI
Middle Name:KAJFEZ
Last Name:BRACKMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARRI
Other - Middle Name:ANN
Other - Last Name:KAJFEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8749
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:205 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8749
Practice Address - Country:US
Practice Address - Phone:910-295-5511
Practice Address - Fax:910-420-1606
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10039969207Q00000X
NC201500906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX557995OtherPHYSICIAN IN TRAINING
TX557995OtherPHYSICIAN IN TRAINING