1720263379 NPI number — DONALD W. BREECH MD PA

Table of content: (NPI 1720263379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720263379 NPI number — DONALD W. BREECH MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONALD W. BREECH MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720263379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 E SAN ANTONIO ST
Provider Second Line Business Mailing Address:
SUITE 410 E
Provider Business Mailing Address City Name:
VICTORIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77901-6061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-578-2911
Provider Business Mailing Address Fax Number:
361-578-4733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 E SAN ANTONIO ST
Provider Second Line Business Practice Location Address:
SUITE 410 E
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77901-6061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-578-2911
Provider Business Practice Location Address Fax Number:
361-578-4733
Provider Enumeration Date:
01/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BREECH
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OFFICER/OWNER
Authorized Official Telephone Number:
361-578-2911

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0085QU . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 194073601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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