=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992834261
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HILLARY ELIZABETH BRUNNER D.P.M.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 04/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2903 BILLY HEXT ROAD
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-550-3668
-----------------------------------------------------
Fax | 432-550-3671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 OASIS
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79765-8574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-550-3668
-----------------------------------------------------
Fax | 432-550-3671
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 1926
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------