MEDICARE: MRS. PATRICIA K BROUGHER 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	H2265	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H2265	OTHER	TX	TX ST BOARD OF MED EXAM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962506022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA K BROUGHER MD

Provider Business Mailing Address
First Line	:	4499 MEDICAL DR STE 140
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3711
Country	:	US
Telephone Number	:	210-692-0831
Fax Number	:	210-692-9202

Provider Business Practice Location Address
First Line	:	4499 MEDICAL DR STE 140
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3711
Country	:	US
Telephone Number	:	210-692-0831
Fax Number	:	210-692-9202

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	05/09/2022

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