Provider Demographics
NPI:1790964013
Name:TERRY BRACKMAN DO INC.
Entity Type:Organization
Organization Name:TERRY BRACKMAN DO INC.
Other - Org Name:BRACKMAN FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-420-3303
Mailing Address - Street 1:3900 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3048
Mailing Address - Country:US
Mailing Address - Phone:479-783-3661
Mailing Address - Fax:
Practice Address - Street 1:3900 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3048
Practice Address - Country:US
Practice Address - Phone:479-783-3661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty