Provider Demographics
NPI:1679798201
Name:BRUCE E. DOUTHIT, MD, PA
Entity type:Organization
Organization Name:BRUCE E. DOUTHIT, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-335-8455
Mailing Address - Street 1:4461 COIT RD
Mailing Address - Street 2:STE 101
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0521
Mailing Address - Country:US
Mailing Address - Phone:972-335-8455
Mailing Address - Fax:972-335-7560
Practice Address - Street 1:4461 COIT RD STE 101
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0522
Practice Address - Country:US
Practice Address - Phone:972-335-8455
Practice Address - Fax:972-335-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8826174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE57513Medicare UPIN
TXH93481Medicare UPIN
TX8B2791Medicare ID - Type UnspecifiedDR MICHELSEN MEDICARE
TX00947VMedicare ID - Type UnspecifiedGROUP MEDICARE
TX5819110001Medicare NSC
TX8B2790Medicare ID - Type UnspecifiedDR. DOUTHIT MEDICARE