Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | S9661 | TX |
NPI | 1144476995 |
---|---|
Provider Name | Brian Robert Braaksma |
First Address | Plano, TX 75093-8172 |
Second Address | Ft Worth, TX 76177-8629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S9661 | TMB (01) | TX |