Provider Demographics
NPI:1942217286
Name:BRAZELL, DONALD SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:SCOTT
Last Name:BRAZELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:D.
Other - Middle Name:SCOTT
Other - Last Name:BRAZELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, FAAFP
Mailing Address - Street 1:14 SPRING CREEK PL
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-3600
Mailing Address - Country:US
Mailing Address - Phone:903-235-3347
Mailing Address - Fax:
Practice Address - Street 1:3350 SW 148TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3259
Practice Address - Country:US
Practice Address - Phone:800-400-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE68788Medicare UPIN
TXE68788Medicare UPIN