MEDICARE: PATRICIA GAIL BRACKEEN 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	363A00000X	Physician Assistant	000771	TX

General Provider Information

NPI Number	:	1588735641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA GAIL BRACKEEN PA

Provider Business Mailing Address
First Line	:	1717 MAIN ST # STRE1ET
Second Line	:	5200
City	:	DALLAS
State	:	TX
Zip	:	75201-4612
Country	:	US
Telephone Number	:	214-712-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 MAIN ST
Second Line	:	5200
City	:	DALLAS
State	:	TX
Zip	:	75201-4612
Country	:	US
Telephone Number	:	214-712-2000
Fax Number	:

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

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	07/09/2007

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Directions to “ PATRICIA GAIL BRACKEEN PA” Practice Location

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