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General NPI Number Information
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NPI Number | 1275134199
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Entity Type | Organization
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Legal Business Name | MEDICAL GROUP OF TEXAS PLLC
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 825 WATTERS CREEK BLVD STE 250
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City | ALLEN
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State | TX
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Zip | 75013-3770
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Country | US
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Telephone | 918-550-3552
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Fax |
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Provider Business Mailing Address
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Address Line | 825 WATTERS CREEK BLVD STE 250
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City | ALLEN
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State | TX
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Zip | 75013-3770
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Country | US
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Telephone | 918-550-3552
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFF SCOTT BROUWER
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Credential |
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Telephone | 602-249-0999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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