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General NPI Number Information
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NPI Number | 1053277087
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Entity Type | Organization
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Legal Business Name | BRACKENRICH BURCH PLLC
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Dates
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Enumeration Date | 01/03/2026
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Last Update Date | 01/03/2026
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Provider Practice Location Address
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Address Line | 1900 W WALL ST
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City | MIDLAND
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State | TX
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Zip | 79701-6527
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Country | US
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Telephone | 432-203-4776
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Fax |
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Provider Business Mailing Address
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Address Line | 3815 SUNBREEZE CIR APT 345
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City | ROANOKE
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State | VA
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Zip | 24018-3172
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. JARED BRACKENRICH
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Credential | DO
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Telephone | 540-808-6645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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