Healthcare Provider Details

I. General information

NPI: 1982807699
Provider Name (Legal Business Name): GVSA MEDICAL PROFESSIONALS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E 29TH ST SUITE 105
BRYAN TX
77802-2531
US

IV. Provider business mailing address

2700 E 29TH ST SUITE 105
BRYAN TX
77802-2531
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-5631
  • Fax:
Mailing address:
  • Phone: 979-776-5631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD D ALFORD
Title or Position: PHYSICIAN AND PRESIDENT
Credential:
Phone: 979-776-5631