Healthcare Provider Details

I. General information

NPI: 1922409101
Provider Name (Legal Business Name): CAPROCK PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3134 BRIARCREST DR
BRYAN TX
77802-3014
US

IV. Provider business mailing address

4711 WESTMINSTER DR
BRYAN TX
77802-5912
US

V. Phone/Fax

Practice location:
  • Phone: 979-314-2323
  • Fax: 979-314-2360
Mailing address:
  • Phone: 979-820-0028
  • Fax: 979-314-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LON YOUNG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 979-314-2323