MEDICARE: BRAZOSPORT COMMUNITY MEDICAL CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	PA00933	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881649747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAZOSPORT COMMUNITY MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	606 N GULF BLVD
Second Line	:
City	:	FREEPORT
State	:	TX
Zip	:	77541-3902
Country	:	US
Telephone Number	:	979-871-9453
Fax Number	:	979-871-9429

Provider Business Practice Location Address
First Line	:	606 N GULF BLVD
Second Line	:
City	:	FREEPORT
State	:	TX
Zip	:	77541-3902
Country	:	US
Telephone Number	:	979-871-9453
Fax Number	:	979-871-9429

Authorized Official
Title or Position	:	CEO/PA
Name	:	MR. INYANG E WILSON
Credential	:	PA
Telephone Number	:	979-871-9453

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	05/04/2015

Similar Medicare Providers

1053359885 — MR. INYANG E WILSON PA
Practice Location Address:

606 N GULF BLVD
FREEPORT, TX
77541-3902

Practice Phone: 979-871-9354
Practice Fax: 979-871-9429

1356593024 — DR. CATHERINE VEGA MARCANTONIO DMD
Practice Location Address:

842 HIGHWAY 20 E STE 102
FREEPORT, FL
32439-3902

Practice Phone: 850-835-5437
Practice Fax: 850-897-5797

1710976691 — MR. MAX GARY HOLLER L.A.T.
Practice Location Address:

1206 W 11TH ST
FREEPORT, TX
77541-5346

Practice Phone: 979-230-0291
Practice Fax:

1114917846 — ATLAS DENTAL LP
Practice Location Address:

1723 N AVENUE K
FREEPORT, TX
77541-3605

Practice Phone: 979-233-1581
Practice Fax: 979-233-8355

1346229135 — MS. SHARMAE R KRAY P.A.-C.
Practice Location Address:

1002 ABC AVE STE 600
FREEPORT, TX
77541-3889

Practice Phone: 979-491-2756
Practice Fax: 979-233-4365

1225006786 — CITY OF FREEPORT
Practice Location Address:

131 E 4TH ST
FREEPORT, TX
77541-5909

Practice Phone: 979-233-2111
Practice Fax: 979-233-4103

Directions to “BRAZOSPORT COMMUNITY MEDICAL CLINIC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.