MEDICARE: DR. TREY GARRETT BRADER 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	207Q00000X	Family Medicine Physician	K5829	TX

General Provider Information

NPI Number	:	1952505711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREY GARRETT BRADER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9101
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-9494
Country	:	US
Telephone Number	:	972-745-7500
Fax Number	:	972-471-0700

Provider Business Practice Location Address
First Line	:	5033 W HIGHWAY 290
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78735-6751
Country	:	US
Telephone Number	:	972-745-7500
Fax Number	:

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	12/19/2016

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