MEDICARE: FRED B BRACKETT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	E7836	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053383372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED B BRACKETT M.D.

Provider Business Mailing Address
First Line	:	4234 WEBER RD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-3603
Country	:	US
Telephone Number	:	361-883-3831
Fax Number	:	361-887-0146

Provider Business Practice Location Address
First Line	:	4234 WEBER RD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-3603
Country	:	US
Telephone Number	:	361-883-3831
Fax Number	:	361-887-0146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	12/18/2018

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