Provider Demographics
NPI:1659674760
Name:BROGDEN, GREGORY JON (ACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JON
Last Name:BROGDEN
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Gender:M
Credentials:ACNP-BC
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Mailing Address - Street 1:113 PLEASANT VALLEY DR
Mailing Address - Street 2:STE 210
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5683
Mailing Address - Country:US
Mailing Address - Phone:830-267-4575
Mailing Address - Fax:210-579-7513
Practice Address - Street 1:1860 S SEGUIN AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3913
Practice Address - Country:US
Practice Address - Phone:210-448-7700
Practice Address - Fax:210-448-7703
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2016-09-20
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Provider Licenses
StateLicense IDTaxonomies
TX663310363LA2100X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12297180OtherCAQH