Healthcare Provider Details

I. General information

NPI: 1952505588
Provider Name (Legal Business Name): BRYAN GENE BREKHUS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 PARKWAY
CORPUS CHRISTI TX
78414-2455
US

IV. Provider business mailing address

PO BOX 270874
CORPUS CHRISTI TX
78427-0874
US

V. Phone/Fax

Practice location:
  • Phone: 361-993-2000
  • Fax:
Mailing address:
  • Phone: 361-654-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN5590
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberN5590
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: