MEDICARE: ANTON B BRUCKS 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
1	207V00000X	Obstetrics & Gynecology Physician	C8208	TX

General Provider Information

NPI Number	:	1174516074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTON B BRUCKS MD

Provider Business Mailing Address
First Line	:	4224 SWISS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-8134
Country	:	US
Telephone Number	:	214-821-9938
Fax Number	:

Provider Business Practice Location Address
First Line	:	4224 SWISS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-8134
Country	:	US
Telephone Number	:	214-821-9938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	10/30/2007

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