MEDICARE: BRIAN K MIDDLEBROOK DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	1704	TX

General Provider Information

NPI Number	:	1932106598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN K MIDDLEBROOK DPM

Provider Business Mailing Address
First Line	:	705 W WADLEY AVE STE 200
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-5370
Country	:	US
Telephone Number	:	432-682-0222
Fax Number	:	432-682-0242

Provider Business Practice Location Address
First Line	:	705 W WADLEY AVE STE 200
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-5370
Country	:	US
Telephone Number	:	432-682-0222
Fax Number	:	432-682-0242

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	05/20/2024

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