Provider Demographics
NPI:1144476995
Name:BRAAKSMA, BRIAN ROBERT (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ROBERT
Last Name:BRAAKSMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6020 W PARKER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8172
Mailing Address - Country:US
Mailing Address - Phone:972-608-5000
Mailing Address - Fax:972-608-5068
Practice Address - Street 1:3025 N TARRANT PKWY STE 220
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8629
Practice Address - Country:US
Practice Address - Phone:817-898-6688
Practice Address - Fax:817-562-8313
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS9661207XS0117X, 207XS0117X
IL036129830207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS9661OtherTMB
TXS9661OtherTMB