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NPI Code Detail

MEDICARE: BRENT D MICHENER DO

MEDICARE: BRENT D MICHENER DO
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
1208600000XSurgery PhysicianM7798TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1M7798OTHERTXTEXAS MEDICAL LICENSE

General Provider Information

NPI Number : 1417165002
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENT D MICHENER DO
Provider Business Mailing Address
First Line : 3270 JOE BATTLE BLVD
Second Line : SUITE 205
City : EL PASO
State : TX
Zip : 79938-2639
Country : US
Telephone Number : 915-855-2400
Fax Number : 915-855-2401
Provider Business Practice Location Address
First Line : 3270 JOE BATTLE BLVD
Second Line : SUITE 205
City : EL PASO
State : TX
Zip : 79938-2639
Country : US
Telephone Number : 915-855-2400
Fax Number : 915-855-2401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 03/11/2013

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Directions to “ BRENT D MICHENER DO” Practice Location

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