Individual
BRENT G BADGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7777 FOREST LN, DALLAS, TX 75230-2505
(972) 566-6575
(972) 566-4703
Mailing address
PO BOX 201606, DALLAS, TX 75320-1606
(972) 758-3598
(972) 599-9604
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03445
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215674701
—
TX
05
—
215674702
—
TX
Enumeration date
02/01/2007
Last updated
04/26/2012
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