Provider Demographics
NPI:1720065709
Name:CARDWELL, BRENT S (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:S
Last Name:CARDWELL
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 15690
Mailing Address - Street 2:DEPT 923
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4051
Mailing Address - Country:US
Mailing Address - Phone:512-336-2777
Mailing Address - Fax:512-336-2778
Practice Address - Street 1:345 CYPRESS CREEK RD
Practice Address - Street 2:STE 104
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4406
Practice Address - Country:US
Practice Address - Phone:512-336-2777
Practice Address - Fax:512-336-2778
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2169208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S5300OtherBCBS PIN
TX8S5300OtherBCBS PIN
TXH41862Medicare UPIN