Provider Demographics
NPI:1003831967
Name:BROFMAN, CARL MARTIN (DC, NP-C)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:MARTIN
Last Name:BROFMAN
Suffix:
Gender:M
Credentials:DC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-4342
Mailing Address - Country:US
Mailing Address - Phone:409-283-1950
Mailing Address - Fax:
Practice Address - Street 1:1820 HARVARD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4342
Practice Address - Country:US
Practice Address - Phone:409-283-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7111111N00000X
TX777173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0071653OtherBLUELINK ID
TX147248201Medicaid
TX8A8401OtherBC/BS PROVIDER ID
TX0034GHOtherBC/BS GROUP
TX8A8401OtherBC/BS PROVIDER ID
TXU67384Medicare UPIN
TX8768M1Medicare ID - Type UnspecifiedMEDICARE PROVIDER