MEDICARE: RACHEL L. BREEDLOVE 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	207V00000X	Obstetrics & Gynecology Physician	57.010678	OH
2	207V00000X	Obstetrics & Gynecology Physician	N2417	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083821243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL L. BREEDLOVE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 26726
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78755-0726
Country	:	US
Telephone Number	:	512-407-8686
Fax Number	:	512-421-4489

Provider Business Practice Location Address
First Line	:	4101 JAMES CASEY #300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-1155
Country	:	US
Telephone Number	:	512-383-9752
Fax Number	:	512-383-9296

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	12/13/2010

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