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General NPI Number Information
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NPI Number | 1053519645
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Entity Type | Individual
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Provider Name | PETER A. BROKISH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 4851 MERLOT AVE UNIT 550
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City | GRAPEVINE
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State | TX
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Zip | 76051-7380
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Country | US
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Telephone | 940-488-4290
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Fax | 940-536-0539
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Provider Business Mailing Address
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Address Line | 5150 LEMMON AVE STE 108
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City | DALLAS
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State | TX
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Zip | 75209-6428
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Country | US
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Telephone | 214-891-5579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD60915016
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | P1852
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License Number State | TX
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