MEDICARE: DR. BRANDEN CHARLES KRET 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
1	208600000X	Surgery Physician	125066547	IL
2	2086S0102X	Surgical Critical Care Physician	53628	KY
3	208600000X	Surgery Physician	T2910	TX

General Provider Information

NPI Number	:	1942689625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDEN CHARLES KRET M.D.

Provider Business Mailing Address
First Line	:	1924 PINE ST
Second Line	:	STE 501
City	:	ABILENE
State	:	TX
Zip	:	79601-2452
Country	:	US
Telephone Number	:	325-670-4333
Fax Number	:	325-670-4336

Provider Business Practice Location Address
First Line	:	1924 PINE ST STE 501
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79601-2452
Country	:	US
Telephone Number	:	325-670-4333
Fax Number	:	325-670-4336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	08/11/2021

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