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:
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Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083933485 NPPES
Missouri MEDICAID 220051288
Missouri MEDICAID 1083933485

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