Provider Demographics
NPI:1891726048
Name:BREITUNG, JASMIN U (MD)
Entity Type:Individual
Prefix:MISS
First Name:JASMIN
Middle Name:U
Last Name:BREITUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4328
Mailing Address - Country:US
Mailing Address - Phone:505-425-1533
Mailing Address - Fax:505-425-1536
Practice Address - Street 1:721 5TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4328
Practice Address - Country:US
Practice Address - Phone:505-425-1533
Practice Address - Fax:505-425-1536
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE334604503Medicare PIN
NEI49426Medicare UPIN