Individual
TIMOTHY CHARLES BRAZEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC, PA
Contact information
Practice address
331 HOSPITAL DR, SUITE D, LEBANON, MO 65536-9217
(417) 533-6315
(417) 533-6320
Mailing address
2851 CLEARVIEW DR, MANSFIELD, MO 65704-7212
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
200901846
MO
363A00000X
Physician Assistant
Primary
2018004459
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083933485
—
MO
05
—
220051288
—
MO
Enumeration date
05/25/2010
Last updated
07/23/2024
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