Healthcare Provider Details

I. General information

NPI: 1285897348
Provider Name (Legal Business Name): BRAZOS ANESTHESIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 BRIARCREST DR SUITE 14
BRYAN TX
77802-2769
US

IV. Provider business mailing address

1737 BRIARCREST DR SUITE 14
BRYAN TX
77802-2769
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-4777
  • Fax: 979-776-0588
Mailing address:
  • Phone: 979-776-4777
  • Fax: 979-776-0588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: KENNI BULGER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 979-776-4777