Provider Demographics
NPI:1417926999
Name:CANLAS, BERNABE BRADEN (DPM)
Entity Type:Individual
Prefix:
First Name:BERNABE
Middle Name:BRADEN
Last Name:CANLAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-334-5032
Mailing Address - Fax:281-334-3932
Practice Address - Street 1:3023 MARINA BAY DR STE 106
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2882
Practice Address - Country:US
Practice Address - Phone:281-334-5032
Practice Address - Fax:281-334-3932
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1678213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167826001Medicaid
TX8M1223OtherBLUE CROSS BLUE SHIELD
TX8K5100Medicare PIN
TX8C2417Medicare PIN
TX8M1223OtherBLUE CROSS BLUE SHIELD
TX5006050002Medicare NSC