Provider Demographics
NPI:1265415640
Name:BRAZEAL, BRAD A (MD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:A
Last Name:BRAZEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:A
Other - Last Name:BRAZEAL MD PA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:300 WILLOW CREEK PKWY
Mailing Address - Street 2:STE 210
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-4389
Mailing Address - Country:US
Mailing Address - Phone:903-723-1940
Mailing Address - Fax:903-723-8307
Practice Address - Street 1:300 WILLOW CREEK PKWY
Practice Address - Street 2:STE 210
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4389
Practice Address - Country:US
Practice Address - Phone:903-723-1940
Practice Address - Fax:903-723-8307
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ32832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166535801Medicaid
TX166535801Medicaid
TXG35336Medicare UPIN