Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2155550 | TX |
NPI | 1043827165 |
---|---|
Provider Name | Morgan Brackin |
First Address | Lumberton, TX 77657-6208 |
Second Address | Silsbee, TX 77656-3635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2020 |
Last Update Date | 24/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2155550 | (05) | TX |