Provider Demographics
NPI:1366516619
Name:BRAKE, GARRY L (MD)
Entity type:Individual
Prefix:MR
First Name:GARRY
Middle Name:L
Last Name:BRAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:210 JONES RD
Mailing Address - Street 2:SUITE 2 5
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540
Mailing Address - Country:US
Mailing Address - Phone:508-540-9771
Mailing Address - Fax:508-540-3158
Practice Address - Street 1:210 JONES RD
Practice Address - Street 2:SUITE 2 5
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-540-9771
Practice Address - Fax:508-540-3158
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA81477208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700749OtherUNITED HEALTH CARE
MA3141055Medicaid
MAB48181OtherBCBS
MA801528OtherHPHC
MA759653OtherTUFTS
1700749OtherUNITED HEALTH CARE
MA759653OtherTUFTS