Provider Demographics
NPI:1972515864
Name:BRASHER, WARREN K (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:K
Last Name:BRASHER
Suffix:
Gender:M
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-3199
Practice Address - Fax:682-885-7199
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8473207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L42VOtherBCBSTX GRP PIN
TX10023730OtherAMERIGROUP PIN
TX109089100OtherFIRSTCARE PIN
TX109960OtherSUPERIOR PIN
TX125089608Medicaid
TX5116917OtherCIGNA PIN
TX125089609OtherCSHCN
TX9165935OtherPHCS PIN
TX5323640OtherAETNA PIN
TX1207830OtherFIRSTHEALTH PIN
TX2015740OtherUHC PIN
TX8A0215OtherBCBSTX IND PIN
TX9165935OtherPHCS PIN
TX125089608Medicaid