Provider Demographics
NPI:1164042339
Name:BROUGHTON, NICHOLAS AARON (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:AARON
Last Name:BROUGHTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:401 N VALLEY PKWY STE 380
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3472
Mailing Address - Country:US
Mailing Address - Phone:469-904-6427
Mailing Address - Fax:
Practice Address - Street 1:5668 EDWARDS RANCH RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4109
Practice Address - Country:US
Practice Address - Phone:817-764-1554
Practice Address - Fax:817-764-1565
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXU5080207Q00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine