Provider Demographics
NPI:1497872303
Name:PACKARD, BRUCE DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DOUGLAS
Last Name:PACKARD
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 1:600 N DAIRY ASHFORD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079
Mailing Address - Country:US
Mailing Address - Phone:281-293-1161
Mailing Address - Fax:281-293-2526
Practice Address - Street 1:600 N DAIRY ASHFORD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079
Practice Address - Country:US
Practice Address - Phone:281-293-1161
Practice Address - Fax:281-293-2526
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA2388207Q00000X
TXL78362083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine