Provider Demographics
NPI:1811458797
Name:BRUETTE, TESS PHAM (MD)
Entity type:Individual
Prefix:DR
First Name:TESS
Middle Name:PHAM
Last Name:BRUETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TESS
Other - Middle Name:LY
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:753 E TRAVIS ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-2353
Mailing Address - Country:US
Mailing Address - Phone:979-968-6596
Mailing Address - Fax:979-968-3001
Practice Address - Street 1:890 E TRAVIS ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2364
Practice Address - Country:US
Practice Address - Phone:844-835-2748
Practice Address - Fax:979-968-2001
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT3592208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics