MEDICARE: DR. KARL BRUNO BRANDENBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	D6233	TX

General Provider Information

NPI Number	:	1831196088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARL BRUNO BRANDENBERG M.D.

Provider Business Mailing Address
First Line	:	6551 HARRIS PKWY
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76132-6102
Country	:	US
Telephone Number	:	817-423-1800
Fax Number	:	817-423-1900

Provider Business Practice Location Address
First Line	:	6551 HARRIS PKWY
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76132-6102
Country	:	US
Telephone Number	:	817-423-1800
Fax Number	:	817-423-1900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/08/2007

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