Individual
MR. JONATHAN REEVES BROUGH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8160 WALNUT HILL LN, SUITE 200, DALLAS, TX 75231-4339
(214) 363-4421
(214) 987-1657
Mailing address
8160 WALNUT HILL LN, SUITE 200, DALLAS, TX 75231-4339
(214) 363-4421
(214) 987-1657
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
H7927
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81590Y
BLUE CROSS/BLUE SHIELD
TX
01
—
H7927
STATE LICENSE
TX
Enumeration date
05/18/2006
Last updated
07/08/2007
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