Provider Demographics
NPI:1720263379
Name:DONALD W. BREECH MD PA
Entity Type:Organization
Organization Name:DONALD W. BREECH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BREECH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-578-2911
Mailing Address - Street 1:605 E SAN ANTONIO ST
Mailing Address - Street 2:SUITE 410 E
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6061
Mailing Address - Country:US
Mailing Address - Phone:361-578-2911
Mailing Address - Fax:361-578-4733
Practice Address - Street 1:605 E SAN ANTONIO ST
Practice Address - Street 2:SUITE 410 E
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6061
Practice Address - Country:US
Practice Address - Phone:361-578-2911
Practice Address - Fax:361-578-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0085QUOtherBLUE CROSS
TX194073601Medicaid
TX194073601Medicaid