MEDICARE: PETER A. BROKISH 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	207P00000X	Emergency Medicine Physician	MD60915016	WA
2	207P00000X	Emergency Medicine Physician	P1852	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P1852	OTHER	TX	TX LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053519645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER A. BROKISH M.D.

Provider Business Mailing Address
First Line	:	5150 LEMMON AVE STE 108
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-6428
Country	:	US
Telephone Number	:	214-891-5579
Fax Number	:

Provider Business Practice Location Address
First Line	:	4851 MERLOT AVE UNIT 550
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-7380
Country	:	US
Telephone Number	:	940-488-4290
Fax Number	:	940-536-0539

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

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	08/01/2024

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Directions to “ PETER A. BROKISH M.D.” Practice Location

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