Individual
MR. BRENT ANDREW HATHCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6606 LBJ FWY, STE 200, DALLAS, TX 75240
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
616833
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157756103
—
TX
01
—
83823U
BCBS
TX
01
—
P00128435
RAILROAD
TX
Enumeration date
12/28/2005
Last updated
06/06/2018
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