Provider Demographics
NPI:1558389981
Name:BRUTON, ROBERT H (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:BRUTON
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:PO BOX 2947
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78299-2947
Mailing Address - Country:US
Mailing Address - Phone:210-892-0228
Mailing Address - Fax:210-455-0169
Practice Address - Street 1:311 CAMDEN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2012
Practice Address - Country:US
Practice Address - Phone:210-892-0228
Practice Address - Fax:210-455-0169
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMPORARY2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00374016OtherMEDICARE RAILROAD
I41190Medicare UPIN
P00374016OtherMEDICARE RAILROAD