Provider Demographics
NPI:1033137435
Name:PRAGER, BRUCE I (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:I
Last Name:PRAGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SECRETARY DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-1623
Mailing Address - Country:US
Mailing Address - Phone:817-468-8400
Mailing Address - Fax:817-468-8512
Practice Address - Street 1:701 SECRETARY DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-1623
Practice Address - Country:US
Practice Address - Phone:817-468-8400
Practice Address - Fax:817-468-8512
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8747207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096819004Medicaid
TX096819005Medicaid
TX096819003Medicaid
TX096819004Medicaid
TX8C9340Medicare ID - Type Unspecified
TX8C9433Medicare ID - Type Unspecified
TX8D3165Medicare ID - Type Unspecified