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NPI Code Detail

MEDICARE: DR. CHEVELLE S BRUDEY M.D.

MEDICARE: DR. CHEVELLE S BRUDEY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0805XGeriatric Psychiatry PhysicianQ0610TX
22084P0800XPsychiatry PhysicianQ0610TX
3207R00000XInternal Medicine PhysicianQ0610TX

General Provider Information

NPI Number : 1902064587
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHEVELLE S BRUDEY M.D.
Provider Business Mailing Address
First Line : PO BOX 797182
Second Line :
City : DALLAS
State : TX
Zip : 75379-7182
Country : US
Telephone Number : 214-420-9301
Fax Number : 659-903-2614
Provider Business Practice Location Address
First Line : 14275 MIDWAY RD STE 200
Second Line :
City : ADDISON
State : TX
Zip : 75001-3618
Country : US
Telephone Number : 214-420-9301
Fax Number : 659-903-2614
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2008
Last Update Date : 05/21/2024

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