Provider Demographics
NPI:1285747030
Name:EWART, BRENDA K (DO)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:EWART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 WINDSOR CENTRE TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1865
Mailing Address - Country:US
Mailing Address - Phone:972-899-8080
Mailing Address - Fax:972-899-1865
Practice Address - Street 1:4300 WINDSOR CENTRE TRL STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1865
Practice Address - Country:US
Practice Address - Phone:972-899-8080
Practice Address - Fax:972-899-1865
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046030504Medicaid
TX046030503Medicaid
TX8K6215Medicare PIN
TXE89489Medicare UPIN
TXTXB122217Medicare PIN
TX8G0747Medicare PIN