Provider Demographics
NPI:1871508739
Name:BROTHERMAN AND MONINGER, LLP
Entity Type:Organization
Organization Name:BROTHERMAN AND MONINGER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNERSHIP
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-241-2564
Mailing Address - Street 1:10 MEDICAL PKWY # 3
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7840
Mailing Address - Country:US
Mailing Address - Phone:972-241-2564
Mailing Address - Fax:972-484-3528
Practice Address - Street 1:10 MEDICAL PKWY # 3
Practice Address - Street 2:SUITE 102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7840
Practice Address - Country:US
Practice Address - Phone:972-241-2564
Practice Address - Fax:972-484-3528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150018301Medicaid
TX150018301Medicaid