Brazeal, Timothy Charles
Brazeal, Timothy Charles is an individual health care provider with primary practice located at 3555 S National Ave , Springfield MO 65807. He recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Brazeal, Timothy Charles can be contacted via phone (417) 875-3000.Contact Information
Primary practice address
3555 S National Ave
Springfield MO 65807
Phone: (417) 875-3000
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer | 2255A2300X | 200901846 | Missouri |
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 2018004459 | Missouri |
Profile Details
NPI number | 1083933485 |
---|---|
LBN Legal business name | Brazeal, Timothy Charles |
Credentials | MS, ATC, PA |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | May 25th, 2010 |
Last updated | Dec 27th, 2018 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1083933485 | NPPES |
Missouri | MEDICAID | 220051288 | |
Missouri | MEDICAID | 1083933485 |
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