Healthcare Provider Details

I. General information

NPI: 1730365305
Provider Name (Legal Business Name): CHAD EDWARD BRASHEAR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR
HAZARD KY
41701
US

IV. Provider business mailing address

3815 HIGHWAY 160 S
HINDMAN KY
41822-9064
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-6782
  • Fax: 606-439-6879
Mailing address:
  • Phone: 606-438-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101017301
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: