MEDICARE: WILLIAM HUGH BRELAND

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	174400000X	Specialist	752803659	TX
2	1744R1103X	Research Study Abstracter/Coder	752803659	TX
3	225100000X	Physical Therapist	4674	NM
4	225100000X	Physical Therapist	1011591	TX
5	225100000X	Physical Therapist	2429	OK

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	:	1518963362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM HUGH BRELAND

Provider Business Mailing Address
First Line	:	1337 GUSDORF RD
Second Line	:	STE I
City	:	TAOS
State	:	NM
Zip	:	87571-7200
Country	:	US
Telephone Number	:	505-641-4768
Fax Number	:	575-758-1810

Provider Business Practice Location Address
First Line	:	208 S RED RIVER EXPY
Second Line	:	STE E
City	:	BURKBURNETT
State	:	TX
Zip	:	76354-3752
Country	:	US
Telephone Number	:	940-569-3630
Fax Number	:	940-569-3752

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	09/13/2016

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Directions to “ WILLIAM HUGH BRELAND ” Practice Location

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