Provider Demographics
NPI:1487866521
Name:ROBERT C BRACE
Entity Type:Organization
Organization Name:ROBERT C BRACE
Other - Org Name:WESLACO FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRACE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:956-969-1063
Mailing Address - Street 1:107 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6033
Mailing Address - Country:US
Mailing Address - Phone:956-969-1063
Mailing Address - Fax:956-969-8372
Practice Address - Street 1:107 W 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6033
Practice Address - Country:US
Practice Address - Phone:956-969-1063
Practice Address - Fax:956-969-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDP548213EP1101X, 213ER0200X, 213ES0103X, 213ES0131X
TXDP1742213EP1101X, 213ER0200X, 213ES0103X, 213ES0131X
TXDP667213EP1101X, 213ER0200X, 213ES0103X, 213ES0131X
TXDP881213EP1101X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCK3394OtherMC RAILROAD GROUP #
TXP00256280OtherMC RAILROAD PTAN
TXP00271639OtherMC RAILROAD PTAN
TX881572Medicare PIN
TXCK3394OtherMC RAILROAD GROUP #
TXP00256280OtherMC RAILROAD PTAN
TXT13414Medicare UPIN
TXT12321Medicare UPIN
TX881571Medicare PIN
TXP00271639OtherMC RAILROAD PTAN
TX0916420002Medicare NSC
TX00LK09Medicare PIN
TXV05383Medicare UPIN