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NPI Code Detail

MEDICARE: DR. RANDALL WALTER BRAUCHLE M.D.

MEDICARE: DR. RANDALL WALTER BRAUCHLE M.D.
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
1207YP0228XPediatric Otolaryngology PhysicianL0047TX
2207YS0012XSleep Medicine (Otolaryngology) PhysicianL0047TX
3207YS0123XFacial Plastic Surgery PhysicianL0047TX
4207YX0007XPlastic Surgery within the Head & Neck (Otolaryngology) PhysicianL0047TX
5207YX0602XOtolaryngic Allergy PhysicianL0047TX
6207YX0905XOtolaryngology/Facial Plastic Surgery PhysicianL0047TX
7207Y00000XOtolaryngology PhysicianL0047TX

General Provider Information

NPI Number : 1124005350
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDALL WALTER BRAUCHLE M.D.
Provider Business Mailing Address
First Line : 2500 TANGLEWILDE
Second Line : SUITE 160
City : HOUSTON
State : TX
Zip : 77063-2123
Country : US
Telephone Number : 713-781-9660
Fax Number : 713-974-3672
Provider Business Practice Location Address
First Line : 10740 N GESSNER RD
Second Line : STE 310
City : HOUSTON
State : TX
Zip : 77064-1240
Country : US
Telephone Number : 281-897-0416
Fax Number : 281-890-8908
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 08/09/2021

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