MEDICARE: BROWNWOOD SPECIALTY GROUP, PA

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	207RI0200X	Infectious Disease Physician	G6479	TX
2	207R00000X	Internal Medicine Physician	K2249	TX
3	207Q00000X	Family Medicine Physician	L3615	TX
4	208600000X	Surgery Physician	E1026	TX
5	363L00000X	Nurse Practitioner	643131	TX
6	207Q00000X	Family Medicine Physician	H0955	TX
7	207Q00000X	Family Medicine Physician	L2503	TX
8	363L00000X	Nurse Practitioner	706322	TX
9	208D00000X	General Practice Physician	D4147	TX
10	363L00000X	Nurse Practitioner	606438	TX
11	363L00000X	Nurse Practitioner	587449	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	0079DJ	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1487696688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWNWOOD SPECIALTY GROUP, PA

Provider Business Mailing Address
First Line	:	2502 CROCKETT DR
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5900
Country	:	US
Telephone Number	:	325-643-5521
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 CROCKETT DR
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5900
Country	:	US
Telephone Number	:	325-643-5521
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GARY N BUTKA
Credential	:	M.D.
Telephone Number	:	325-643-5521

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	05/15/2013

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1780796656 — HALBERT OWEN WOODWARD JR. MD
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Practice Location Address:

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Directions to “BROWNWOOD SPECIALTY GROUP, PA ” Practice Location

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