Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 0591 | TX |
NPI | 1598738148 |
---|---|
Provider Name | Dr. Ronald James Bruscia |
First Address | Katy, TX 77450-3896 |
Second Address | Katy, TX 77450-3896 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 03/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T12431 | (02) | TX |
TPI0927600 | (05) | TX |