Organization
BRECKENRIDGE FAMILY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM ELMO PRATER MD (MD PRESIDENT)
(254) 559-3363
Entity
Organization
Contact information
Practice address
103 SOUTH HARTFORD STREET, BRECKENRIDGE, TX 76424
(254) 559-3363
(254) 559-1252
Mailing address
103 SOUTH HARTFORD STREET, BRECKENRIDGE, TX 76424
(254) 559-3363
(254) 559-1252
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G8349
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82J127
BLUE CROSS BLUE SHIELD
TX
Enumeration date
09/21/2006
Last updated
12/12/2007
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