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General NPI Number Information
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NPI Number | 1881155604
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Entity Type | Individual
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Provider Name | ANTONIO THOMAS BRECEVICH MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 1010 SPRUCE ST 3RD FLOOR AREA 4 GENERAL SURGERY
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City | ESPANOLA
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State | NM
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Zip | 87532-2724
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Country | US
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Telephone | 505-367-0340
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Fax | 505-367-0346
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PRESBYTERIAN HEALTHCARE SERVICE
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 832-325-7125
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Fax | 713-512-2200
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD2024-1093
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License Number State | NM
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