Organization
ROBERT C BRACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY GONGORA (OFFICE MANAGER)
(956) 682-4187
Entity
Organization
Contact information
Practice address
533 PECAN BLVD, MCALLEN, TX 78501-2356
(956) 682-4187
(956) 682-9739
Mailing address
533 PECAN BLVD, MCALLEN, TX 78501-2356
(956) 682-4187
(956) 682-9739
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
0548
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127193403
—
TX
01
—
160138702
MEDICAID DME
TX
Enumeration date
02/01/2008
Last updated
02/01/2008
Update your record
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