Provider Demographics
NPI:1356435440
Name:BRECKLER, GWENDA L (DO)
Entity type:Individual
Prefix:MS
First Name:GWENDA
Middle Name:L
Last Name:BRECKLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 MEDICAL ARTS DR STE 3
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9391
Mailing Address - Country:US
Mailing Address - Phone:812-683-4900
Mailing Address - Fax:812-683-3206
Practice Address - Street 1:1706 MEDICAL ARTS DR STE 3
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9391
Practice Address - Country:US
Practice Address - Phone:812-683-4900
Practice Address - Fax:812-683-3206
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002504A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H75101Medicare UPIN
IN247960AMedicare PIN