Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 7111 | TX |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 777173 | TX |
NPI | 1003831967 |
---|---|
Provider Name | Dr. Carl Martin Brofman |
First Address | Houston, TX 77008-4342 |
Second Address | Houston, TX 77008-4342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 29/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0034GH | BC/BS GROUP (01) | TX |
0071653 | BLUELINK ID (01) | TX |
147248201 | (05) | TX |
8A8401 | BC/BS PROVIDER ID (01) | TX |
U67384 | (02) | TX |