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General NPI Number Information
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NPI Number | 1497047708
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Entity Type | Organization
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Legal Business Name | GUILLERMO E BRACHETTA MD PA
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 2300 W MICHIGAN AVE STE 1
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City | MIDLAND
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State | TX
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Zip | 79701-5855
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Country | US
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Telephone | 432-687-0181
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Fax | 432-687-1003
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Provider Business Mailing Address
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Address Line | 2300 W MICHIGAN AVE STE 1
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City | MIDLAND
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State | TX
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Zip | 79701-5855
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Country | US
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Telephone | 432-687-0181
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Fax | 432-687-1003
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Authorized Official
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Title or Position | OWNER
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Name | DR. GUILLERMO E BRACHETTA
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Credential | MDPA
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Telephone | 432-687-0181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | F5845
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License Number State | TX
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