MEDICARE: BRIAN ROBERT BRAAKSMA MD

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	S9661	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S9661	OTHER	TX	TMB

General Provider Information

NPI Number	:	1144476995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN ROBERT BRAAKSMA MD

Provider Business Mailing Address
First Line	:	6020 W PARKER RD STE 200
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-8172
Country	:	US
Telephone Number	:	972-608-5000
Fax Number	:	972-608-5068

Provider Business Practice Location Address
First Line	:	3025 N TARRANT PKWY STE 220
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76177-8629
Country	:	US
Telephone Number	:	817-898-6688
Fax Number	:	817-562-8313

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	11/30/2021

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