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NPI Code Detail

MEDICARE: DR. LATHA MARY BRUBAKER MD

MEDICARE: DR. LATHA MARY BRUBAKER MD
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
1207Q00000XFamily Medicine PhysicianMD00041537WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043280886
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LATHA MARY BRUBAKER MD
Provider Business Mailing Address
First Line : 5080 SPECTRUM DR
Second Line : SUITE 1200 WEST
City : ADDISON
State : TX
Zip : 75001-4648
Country : US
Telephone Number : 800-232-3550
Fax Number :
Provider Business Practice Location Address
First Line : 12345 KATY FWY
Second Line : SUITE 200
City : HOUSTON
State : TX
Zip : 77079-1503
Country : US
Telephone Number : 281-679-5600
Fax Number : 281-679-6510
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2006
Last Update Date : 03/31/2009

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