Provider Demographics
NPI:1700163060
Name:BRENDA L. AXMANN, M.D P.A.
Entity Type:Organization
Organization Name:BRENDA L. AXMANN, M.D P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:AXMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-378-0068
Mailing Address - Street 1:6124 W PARKER RD STE 334
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8123
Mailing Address - Country:US
Mailing Address - Phone:972-378-0068
Mailing Address - Fax:
Practice Address - Street 1:6124 W PARKER RD STE 334
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8123
Practice Address - Country:US
Practice Address - Phone:972-378-0068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5417261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty