Provider Demographics
NPI:1932106598
Name:MIDDLEBROOK, BRIAN K (DPM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:MIDDLEBROOK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 W WADLEY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-5370
Mailing Address - Country:US
Mailing Address - Phone:432-682-0222
Mailing Address - Fax:432-682-0242
Practice Address - Street 1:1300 W WALL ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6625
Practice Address - Country:US
Practice Address - Phone:432-682-0222
Practice Address - Fax:432-682-0242
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1704213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV02272Medicare UPIN
TX5867300001Medicare NSC
TX8F3543Medicare PIN