Healthcare Provider Details

I. General information

NPI: 1881155604
Provider Name (Legal Business Name): ANTONIO THOMAS BRECEVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SPRUCE ST 3RD FLOOR AREA 4 GENERAL SURGERY
ESPANOLA NM
87532-2724
US

IV. Provider business mailing address

PO BOX 26666 PRESBYTERIAN HEALTHCARE SERVICE
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-367-0340
  • Fax: 505-367-0346
Mailing address:
  • Phone: 832-325-7125
  • Fax: 713-512-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2024-1093
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: