Basic Information
| Provider Information | |||||||||
| NPI: | 1346358413 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BREELING | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 S ALAMEDA ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784111882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618572900 | ||||||||
| FaxNumber: | 3618578321 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 S ALAMEDA ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784111882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618572900 | ||||||||
| FaxNumber: | 3618578321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | F9232 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 138033904 | 05 | TX | MEDICAID |