Provider Demographics
NPI:1194929257
Name:HAMBRICK, BRENT ALLEN (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:ALLEN
Last Name:HAMBRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2437 SHETLAND DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3160
Mailing Address - Country:US
Mailing Address - Phone:972-223-4571
Mailing Address - Fax:214-712-2487
Practice Address - Street 1:2850 STATE HIGHWAY 114E
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262
Practice Address - Country:US
Practice Address - Phone:682-831-1700
Practice Address - Fax:214-712-2487
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH5774207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE19530Medicare UPIN