Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 39556 | NC |
NPI | 1003853417 |
---|---|
Provider Name | Henry David Bruton |
First Address | Sneads Ferry, NC 28460-9101 |
Second Address | Amarillo, TX 79106-1729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 19/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129798806 | (05) | TX |
363039ZGE1 | (02) | TX |