Provider Demographics
NPI:1184713513
Name:BREECH, DONALD W (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:BREECH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E SAN ANTONIO ST STE 410E
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6061
Mailing Address - Country:US
Mailing Address - Phone:361-578-2911
Mailing Address - Fax:361-578-4733
Practice Address - Street 1:605 E SAN ANTONIO ST STE 410
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6040
Practice Address - Country:US
Practice Address - Phone:361-578-2911
Practice Address - Fax:361-578-4733
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0832207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114565804Medicaid
TX82920FOtherBLUE CROSS
TX8AV360OtherBLUE CROSS
TX114565803Medicaid
TX00Y694Medicare PIN
TX114565804Medicaid
TXC13733Medicare UPIN
TX82920FMedicare PIN