Charles R Broman, M.D.
Individual provider Active NPI Specialist · Dickinson, TX
NPI 1891798666 · NPPES record last updated Oct 23, 2012
Key facts
- NPI
- 1891798666
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- D2990 (TX)
- Practice address
- 313 FM 517 Rd W
Dickinson, TX 77539-4009 - Phone
- (281) 534-7141
- Fax
- (281) 534-7223
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D2990 | TX | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mainland Urology Clinic PA | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | D2990 | TX | Yes |
Addresses
Primary practice location
313 FM 517 Rd W
Dickinson, TX 77539-4009
Mailing address
313 FM 517 Rd W
Dickinson, TX 77539-4009
Phone (281) 534-7141
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 098105201 | Medicaid | TX |
Other providers in Dickinson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.