Provider Demographics
NPI:1437103074
Name:BRUTON, PATRICK (DPM)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BRUTON
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 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-437-2001
Mailing Address - Fax:325-437-2011
Practice Address - Street 1:1665 ANTILLEY RD STE 230
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606
Practice Address - Country:US
Practice Address - Phone:325-437-2001
Practice Address - Fax:325-437-2011
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1589213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L0790Medicare PIN
4791770001Medicare NSC
TXU91235Medicare UPIN