Provider Demographics
NPI:1093701468
Name:PAULGER, BRENT R (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:R
Last Name:PAULGER
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 1:2202 ITHACA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1332
Mailing Address - Country:US
Mailing Address - Phone:806-797-1202
Mailing Address - Fax:806-797-4854
Practice Address - Street 1:2202 ITHACA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1332
Practice Address - Country:US
Practice Address - Phone:806-797-1202
Practice Address - Fax:806-797-4854
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6653207ND0101X, 207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM004352OtherBCBS NEW MEXICO
TX070014509OtherHMO BLUE
TX121179100OtherFIRST CARE
TX8412K0OtherBCBS TEXAS
NMNM004352OtherBCBS NEW MEXICO
NMNM004352OtherBCBS NEW MEXICO
TX144011Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NMS1625Medicaid