Individual ProviderDominic BraceroInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address1100 Wilford Hall Loop, Jbsa Lackland, TX 78236-5638(210) 292-7805(210) 298-2483PECOS EnrollmentBased on the most recent information from CMS, provider Dominic Bracero is legally eligible to order and refer claims for DME and PMD services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records today at 12:57 PM.Profile DetailsProvider ID1982235388Provider TypeIndividualFull NameBracero, DominicCredentialMDGenderMaleSole ProprietorNoEnumeration Date2/4/2020Last Updated7/2/2024Contact InformationPractice LocationPractice Address1100 Wilford Hall Loop, Jbsa Lackland, TX 78236-5638Phone(210) 292-7805FaxUnlisted FaxMailing LocationMailing Address1100 Wilford Hall Loop, Jbsa Lackland, TX 78236-5638Phone(210) 298-2483Fax(210) 292-7964Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseU9215TexasCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense0101274713VirginiaCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer