=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346529765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAZORIA SLEEP EXPERTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2011
-----------------------------------------------------
Last Update Date | 08/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2315 E. MULBERRY STREET
-----------------------------------------------------
City | ANGLETON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77515-3804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-849-7704
-----------------------------------------------------
Fax | 979-848-8563
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2315 E. MULBERRY STREET
-----------------------------------------------------
City | ANGLETON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77515-3804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-849-7704
-----------------------------------------------------
Fax | 979-848-8563
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LARRY KEITH PARKER
-----------------------------------------------------
Credential | DM
-----------------------------------------------------
Telephone | 979-849-7704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------