Provider Demographics
NPI:1972062339
Name:DENISE BRUCKERHOFF DO PLLC
Entity type:Organization
Organization Name:DENISE BRUCKERHOFF DO PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCKERHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:806-335-5975
Mailing Address - Street 1:9101 LBJ FWY STE 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1912
Mailing Address - Country:US
Mailing Address - Phone:214-506-2617
Mailing Address - Fax:
Practice Address - Street 1:1788 HIGHWAY 157 N STE 103
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3929
Practice Address - Country:US
Practice Address - Phone:817-755-1005
Practice Address - Fax:214-506-2617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty