Basic Information
| Provider Information | |||||||||
| NPI: | 1578621272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROUGHTON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 531768 | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785531768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563896565 | ||||||||
| FaxNumber: | 9563893780 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 PEASE ST | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785508348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563896565 | ||||||||
| FaxNumber: | 9563893780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 06/08/2017 | ||||||||
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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 | 207R00000X | 2002014382 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | N0662 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2002014382 | MO | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 110242252 | 01 | RAILROAD MEDICARE | OTHER | 205890304 | 05 | MO | MEDICAID | 431560263010 | 01 | TRICARE | OTHER |