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General NPI Number Information
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NPI Number | 1619424157
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Entity Type | Organization
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Legal Business Name | EMVIDER MEDICAL PROFESSIONALS, LLC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 3131 UNIVERSITY DR E
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City | BRYAN
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State | TX
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Zip | 77802-3473
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Country | US
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Telephone | 979-731-3180
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Fax |
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Provider Business Mailing Address
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Address Line | 8806 GREEN BRANCH LOOP
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City | BRYAN
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State | TX
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Zip | 77808
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JOHN DAVIDHIZAR JR.
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Credential | MD
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Telephone | 936-661-1556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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