Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | F3774 | TX |
NPI | 1285622795 |
---|---|
Provider Name | Walter Grant Braly |
First Address | Houston, TX 77030-4509 |
Second Address | Houston, TX 77030-4509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 20/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
086M124 | MEDICARE ID (01) | TX |
133937603 | (05) | TX |
B21456 | (02) | TX |