Provider Demographics
NPI:1891798666
Name:BROMAN, CHARLES R (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:BROMAN
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 1:313 FM 517 RD W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4009
Mailing Address - Country:US
Mailing Address - Phone:281-534-7141
Mailing Address - Fax:281-534-7223
Practice Address - Street 1:313 FM 517 RD W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-4009
Practice Address - Country:US
Practice Address - Phone:281-534-7141
Practice Address - Fax:281-534-7223
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2990174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098105201Medicaid
TXC13790Medicare UPIN
TX098105201Medicaid