Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G8747 | TX |
NPI | 1033137435 |
---|---|
Provider Name | Bruce I Prager |
First Address | Arlington, TX 76014-3107 |
Second Address | Arlington, TX 76014-3107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 06/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
096819003 | (05) | TX |
096819004 | (05) | TX |
096819005 | (05) | TX |
B25615 | (02) | TX |