Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | S5851 | TX |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | S5851 | TX |
NPI | 1366862666 |
---|---|
Provider Name | Adam Brekke |
First Address | Fort Worth, TX 76132-4266 |
Second Address | Fort Worth, TX 76132-4266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2014 |
Last Update Date | 01/09/2020 |