Healthcare Provider Details

I. General information

NPI: 1992384382
Provider Name (Legal Business Name): WIFI MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 UNIVERSITY DR E STE 320
BRYAN TX
77802-3478
US

IV. Provider business mailing address

3201 UNIVERSITY DR E STE 320
BRYAN TX
77802-3478
US

V. Phone/Fax

Practice location:
  • Phone: 970-330-7140
  • Fax:
Mailing address:
  • Phone: 979-330-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: BEN JOSEPH ELIZONDO
Title or Position: MANAGER
Credential:
Phone: 979-330-7140