Individual
JOHN W BRAZZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
125 S 20TH ST, PADUCAH, KY 42001
(270) 575-3247
(270) 442-7335
Mailing address
PO BOX 497, AUGUSTA, AR 72006-0497
(870) 347-2534
(870) 347-3492
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
19912
KY
207Q00000X
Family Medicine Physician
Primary
19912
KY
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
19912
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64199128
—
KY
01
—
P00919781
RR MEDICARE
KY
Enumeration date
09/27/2005
Last updated
05/04/2022
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