Individual
DR. EDWARD JOHN BRANDECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1888 ANTILLEY RD, ABILENE, TX 79606-5205
(325) 795-9550
(325) 795-9537
Mailing address
1888 ANTILLEY RD, ABILENE, TX 79606-5205
(325) 795-9550
(325) 795-9537
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
J2508
TX
208100000X
Physical Medicine & Rehabilitation Physician
Primary
J2508
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102408501
—
TX
01
—
102408503
MEDICAID/ADC
TX
01
—
109067100
FIRSTCARE
—
01
—
109067104
FIRSTCARE/ADC
TX
01
—
250003414
MEDICARE RR
—
01
—
4223641
AETNA
—
01
—
81T422
BCBS
—
01
—
8X7151
BCBS/ADC
TX
01
—
CR1046
MCR RXR
TX
Enumeration date
06/21/2005
Last updated
09/25/2012
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