Provider Demographics
NPI:1134445976
Name:NORTH TEXAS BREAST & PLASTIC SURGERY CENTER P.A.
Entity type:Organization
Organization Name:NORTH TEXAS BREAST & PLASTIC SURGERY CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:HERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-387-4900
Mailing Address - Street 1:2900 N I-35
Mailing Address - Street 2:MOB 1, SUITE 409
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-5141
Mailing Address - Country:US
Mailing Address - Phone:940-387-4900
Mailing Address - Fax:940-387-4966
Practice Address - Street 1:2900 N I-35
Practice Address - Street 2:MOB 1, SUITE 409
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5141
Practice Address - Country:US
Practice Address - Phone:940-387-4900
Practice Address - Fax:940-387-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0005TNOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX2138786-01Medicaid
TXTXB105752Medicare PIN