MEDICARE: BRIDLEWOOD FAMILY HEALTHCARE, P.A.

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	261QP2300X	Primary Care Clinic/Center		TX

General Provider Information

NPI Number	:	1821218652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDLEWOOD FAMILY HEALTHCARE, P.A.

Provider Business Mailing Address
First Line	:	3400 LONG PRAIRIE ROAD
Second Line	:	SUITE 200
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-2706
Country	:	US
Telephone Number	:	972-899-6300
Fax Number	:	972-899-6020

Provider Business Practice Location Address
First Line	:	3400 LONG PRAIRIE ROAD
Second Line	:	SUITE 200
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-2706
Country	:	US
Telephone Number	:	972-899-6300
Fax Number	:	972-899-6020

Authorized Official
Title or Position	:	OWNER
Name	:	BRIAN D GLASER
Credential	:	D.O.
Telephone Number	:	972-899-6300

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/21/2022

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