Healthcare Provider Details

I. General information

NPI: 1962856591
Provider Name (Legal Business Name): TEXAS HONOR ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 CAMP BOWIE BLVD STE 114-188
FORT WORTH TX
76107
US

IV. Provider business mailing address

5000 ELDORADO PKWY # 150-330
FRISCO TX
75033-8695
US

V. Phone/Fax

Practice location:
  • Phone: 469-400-4217
  • Fax:
Mailing address:
  • Phone: 972-980-0500
  • Fax: 972-980-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberQ7656
License Number StateTX

VIII. Authorized Official

Name: DR. PATRICK JAMES BRUSCIA
Title or Position: MANAGING MEMBER
Credential: D.O.
Phone: 469-400-4217