Individual
BRENT CLAYTON BREEDLOVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-9733
(336) 716-6674
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-6674
(336) 716-9188
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
001011324
NC
363A00000X
Physician Assistant
Primary
0010-11324
NC
Other
Enumeration date
06/16/2021
Last updated
12/24/2024
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