Healthcare Provider Details

I. General information

NPI: 1518353192
Provider Name (Legal Business Name): JESUS ALFREDO CORREA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JESUS ALFREDO CORREA JR. MD

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 FRANCISCAN DR
BRYAN TX
77802-2544
US

IV. Provider business mailing address

2800 S TEXAS AVE STE 202
BRYAN TX
77802-5361
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-5967
  • Fax: 979-731-5916
Mailing address:
  • Phone: 979-680-5474
  • Fax: 979-680-5478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0089143
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD.61122723
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberD0089143
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberS2750
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: