MEDICARE: EL PASO PRIMARY HEALTHCARE PHYSICIANS, P.A.

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	207R00000X	Internal Medicine Physician	E5012	TX

General Provider Information

NPI Number	:	1639120892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL PASO PRIMARY HEALTHCARE PHYSICIANS, P.A.

Provider Business Mailing Address
First Line	:	11880 VISTA DEL SOL DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-6128
Country	:	US
Telephone Number	:	915-855-7900
Fax Number	:	915-855-7755

Provider Business Practice Location Address
First Line	:	11880 VISTA DEL SOL DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-6128
Country	:	US
Telephone Number	:	915-855-7900
Fax Number	:	915-855-7755

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OLMER R BROOKER
Credential	:	M.D.
Telephone Number	:	915-855-7900

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	06/18/2013

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