Provider Demographics
NPI:1003807744
Name:BRACY, WALDO P JR (MD)
Entity type:Individual
Prefix:DR
First Name:WALDO
Middle Name:P
Last Name:BRACY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2213
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:1001 N WALDROP DR
Practice Address - Street 2:STE. 509
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4705
Practice Address - Country:US
Practice Address - Phone:817-394-4300
Practice Address - Fax:817-394-0200
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH7700207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F7166OtherBCBS
TX131696008Medicaid
TX081585402Medicaid
TXH7700OtherMEDICAL LICENSE
TX131696008Medicaid
TXP00412809Medicare PIN
TXH7700OtherMEDICAL LICENSE