Provider Demographics
NPI:1295094845
Name:BRAM-MOSTYN, AVRAM AARON (DO)
Entity type:Individual
Prefix:DR
First Name:AVRAM
Middle Name:AARON
Last Name:BRAM-MOSTYN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:850 CENTRAL PKWY E
Mailing Address - Street 2:275
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5561
Mailing Address - Country:US
Mailing Address - Phone:972-881-4688
Mailing Address - Fax:972-881-4609
Practice Address - Street 1:850 CENTRAL PKWY E
Practice Address - Street 2:275
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5561
Practice Address - Country:US
Practice Address - Phone:972-881-4688
Practice Address - Fax:972-881-4609
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP5038208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8552NDOtherBCBS
TXP5038OtherSTATE LICENSE
TX2035487-02OtherGROUP TPI
TXTXB102731OtherIND