Individual
MR. GEORGE BRASINIKAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
516 E. NIZHONI BLVD., GALLUP, NM 87301-1337
(505) 722-1000
(505) 726-8598
Mailing address
PO BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
(505) 726-8598
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
MD0000035755
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
62601571
—
NM
05
—
790643
—
AZ
Enumeration date
05/24/2006
Last updated
04/11/2008
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