Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | BP10028684 | TX |
NPI | 1033163589 |
---|---|
Provider Name | Nathan Bruck |
First Address | Dallas, TX 75265-0500 |
Second Address | Dallas, TX 75246-1791 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 08/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I43828 | (02) |