Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0548 | TX |
N | 222Z00000X | Podiatrist | 0548 | TX |
Y | 213EP1101X | Primary Podiatric Medicine | 0548 | TX |
N | 2081S0010X | Sports Medicine | 0548 | TX |
N | 213ES0000X | Sports Medicine | 0548 | TX |
N | 213ES0131X | Foot Surgery | 0548 | TX |
NPI | 1528052156 |
---|---|
Provider Name | Dr. Robert C Brace |
First Address | Mcallen, TX 78501-2356 |
Second Address | Mcallen, TX 78501-2356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 27/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127193403 | (05) | TX |
160138702 | MEDICAID DME (01) | TX |
T12321 | (02) |