Provider Demographics
NPI:1689670564
Name:BRACE GAUL, KATHLEEN A (DPM)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:BRACE GAUL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 LUBBOCK ST
Mailing Address - Street 2:STE B
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8235
Mailing Address - Country:US
Mailing Address - Phone:956-428-2442
Mailing Address - Fax:956-428-3132
Practice Address - Street 1:1911 LUBBOCK ST
Practice Address - Street 2:STE B
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8235
Practice Address - Country:US
Practice Address - Phone:956-428-2442
Practice Address - Fax:956-428-3132
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
TX0667213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13414Medicare UPIN