Individual
DR. JEFFRY ALAN BRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1845 PRECINCT LINE RD STE 209, HURST, TX 76054-3109
(817) 336-4638
(817) 336-7637
Mailing address
1845 PRECINCT LINE RD STE 209, HURST, TX 76054-3109
(817) 336-4638
(817) 336-7637
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
P0894
TX
2085R0202X
Diagnostic Radiology Physician
Primary
P0894
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301740203
—
TX
01
—
311275YTVP
MEDICARE PTAN
TX
Enumeration date
06/28/2010
Last updated
08/18/2016
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