Brackenrich, Wayne Lee
Brackenrich, Wayne Lee is an individual health care provider with primary practice located at 6415 Peters Creek Rd , Roanoke VA 24019-4021. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Brackenrich, Wayne Lee can be contacted via phone (540) 265-5500.Contact Information
Primary practice address
6415 Peters Creek Rd
Roanoke VA 24019-4021
Phone: (540) 265-5500
Fax: (540) 265-5515
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 0102033442 | Virginia |
Profile Details
| NPI number | 1447356530 |
|---|---|
| LBN Legal business name | Brackenrich, Wayne Lee |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 15th, 2006 |
| Last updated | Jun 26th, 2024 - about 2 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 | 1447356530 | NPPES |
| Virginia | MEDICAID | 1447356530 | |
| Virginia | MEDICAID | 005696101 |
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