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General NPI Number Information
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NPI Number | 1972062339
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Entity Type | Organization
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Legal Business Name | DENISE BRUCKERHOFF DO PLLC
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Dates
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Enumeration Date | 03/15/2019
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 1788 HIGHWAY 157 N STE 103
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City | MANSFIELD
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State | TX
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Zip | 76063-3929
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Country | US
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Telephone | 817-755-1005
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Fax | 214-506-2617
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Provider Business Mailing Address
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Address Line | 9101 LBJ FWY STE 710
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City | DALLAS
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State | TX
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Zip | 75243-1912
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Country | US
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Telephone | 214-506-2617
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DENISE BRUCKERHOFF
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Credential | DO
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Telephone | 806-335-5975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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