MEDICARE: CHARLES R BROMAN 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
1	174400000X	Specialist	D2990	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1891798666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES R BROMAN M.D.

Provider Business Mailing Address
First Line	:	313 FM 517 RD W
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-4009
Country	:	US
Telephone Number	:	281-534-7141
Fax Number	:	281-534-7223

Provider Business Practice Location Address
First Line	:	313 FM 517 RD W
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-4009
Country	:	US
Telephone Number	:	281-534-7141
Fax Number	:	281-534-7223

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/23/2012

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