Healthcare Provider Details

I. General information

NPI: 1013268937
Provider Name (Legal Business Name): BRANDON M. GOETZ N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 PINE ST
ABILENE TX
79601-2432
US

IV. Provider business mailing address

1633 COTTONWOOD ST
ABILENE TX
79601-3033
US

V. Phone/Fax

Practice location:
  • Phone: 325-670-2151
  • Fax: 405-321-4603
Mailing address:
  • Phone: 325-672-4372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number698724
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: