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General NPI Number Information
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NPI Number | 1093701468
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Entity Type | Individual
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Provider Name | BRENT R. PAULGER M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 05/22/2020
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Provider Practice Location Address
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Address Line | 2202 ITHACA AVE
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City | LUBBOCK
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State | TX
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Zip | 79410-1332
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Country | US
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Telephone | 806-797-1202
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Fax | 806-797-4854
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Provider Business Mailing Address
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Address Line | 2202 ITHACA AVE
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City | LUBBOCK
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State | TX
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Zip | 79410-1332
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Country | US
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Telephone | 806-797-1202
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Fax | 806-797-4854
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | J6653
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | J6653
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | J6653
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License Number State | TX
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