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General NPI Number Information
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NPI Number | 1629142955
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Entity Type | Individual
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Provider Name | CECIL BRIAN BREETZKE MD
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 1060 PEERLESS XING NW SUITE 200
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City | CLEVELAND
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State | TN
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Zip | 37312-3784
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Country | US
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Telephone | 423-479-4165
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Fax | 423-478-1884
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Provider Business Mailing Address
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Address Line | 1060 PEERLESS XING NW SUITE 200
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City | CLEVELAND
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State | TN
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Zip | 37312-3784
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Country | US
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Telephone | 423-479-4165
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Fax | 423-478-1884
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37479
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License Number State | TN
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