Provider Demographics
NPI:1962449827
Name:BROUGHTON, GEORGE II (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:BROUGHTON
Suffix:II
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16702 BASIN OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-6219
Mailing Address - Country:US
Mailing Address - Phone:214-704-0300
Mailing Address - Fax:
Practice Address - Street 1:16702 BASIN OAK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-6219
Practice Address - Country:US
Practice Address - Phone:214-704-0300
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1277208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF97152Medicare UPIN