Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | D4053 | TX |
NPI | 1033115357 |
---|---|
Provider Name | Daniel Edward Bruhl |
First Address | Fort Worth, TX 76102-4427 |
Second Address | Fort Worth, TX 76102-4427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 05/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
135600801 | (05) | TX |
88Z902 | BCBS (01) | TX |
B21536 | (02) | TX |