Provider Demographics
NPI:1962506022
Name:BROUGHER, PATRICIA K (MD)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:K
Last Name:BROUGHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4499 MEDICAL DR STE 140
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3711
Mailing Address - Country:US
Mailing Address - Phone:210-692-0831
Mailing Address - Fax:210-692-9202
Practice Address - Street 1:4499 MEDICAL DR STE 140
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3711
Practice Address - Country:US
Practice Address - Phone:210-692-0831
Practice Address - Fax:210-692-9202
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2265207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH2265OtherTX ST BOARD OF MED EXAM
TX033130801Medicaid
TX00F24BMedicare ID - Type Unspecified
TX033130801Medicaid