Healthcare Provider Details

I. General information

NPI: 1568435774
Provider Name (Legal Business Name): BRAZOS RADIATION ONCOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 E VILLA MARIA RD SUITE 130
BRYAN TX
77802-2548
US

IV. Provider business mailing address

PO BOX 2289
COPPELL TX
75019-8289
US

V. Phone/Fax

Practice location:
  • Phone: 979-774-0808
  • Fax: 979-776-3028
Mailing address:
  • Phone: 972-745-1429
  • Fax: 972-393-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALVIN LEE SCHLICHTEMEIER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 979-774-0808