Basic Information
| Provider Information | |||||||||
| NPI: | 1477797017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROFER | ||||||||
| FirstName: | RUSSELL | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9101 | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750199494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727457500 | ||||||||
| FaxNumber: | 9727454376 | ||||||||
| Practice Location | |||||||||
| Address1: | 5405 S COOPER ST | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760176148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174654928 | ||||||||
| FaxNumber: | 8174720758 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2009 | ||||||||
| LastUpdateDate: | 09/07/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | K2856 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.