Provider Demographics
NPI:1245434034
Name:BROKER, HARSHAL SUNIL (MD)
Entity type:Individual
Prefix:
First Name:HARSHAL
Middle Name:SUNIL
Last Name:BROKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-927-4323
Practice Address - Street 1:1250 8TH AVE., SUITE 240
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4124
Practice Address - Country:US
Practice Address - Phone:817-927-0456
Practice Address - Fax:817-927-4323
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM39322086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193053901Medicaid
TXP00643336OtherRAIL ROAD MEDICARE
TX193053904OtherOUT OF COUNTY CSHCN