Provider Demographics
NPI:1629027792
Name:BROXSON, TAMMY L (MD)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:L
Last Name:BROXSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAMMY
Other - Middle Name:ZUBER
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5470 W. LOVERS LANE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209
Mailing Address - Country:US
Mailing Address - Phone:214-956-7337
Mailing Address - Fax:469-364-8724
Practice Address - Street 1:5470 W. LOVERS LANE
Practice Address - Street 2:SUITE 330
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209
Practice Address - Country:US
Practice Address - Phone:214-956-7337
Practice Address - Fax:469-364-8724
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4488208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL4488OtherMEDICAL LICENSE
TX05-0622563OtherTAX NUMBER
TX7313193OtherAETNA PIN NUMBER
TX0020KWOtherBCBS PROVIDER ID