Individual
DR. NATHAN BREAZEALE
Active
Individual
DR. NATHAN BREAZEALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
J1500
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102491102
—
TX
01
—
1278600001
MEDICARE SUPPLIER NUMBER
TX
Enumeration date
01/24/2006
Last updated
02/03/2011
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