MEDICARE: BRAESWOOD MEDICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1508173113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAESWOOD MEDICAL

Provider Business Mailing Address
First Line	:	7535 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1423
Country	:	US
Telephone Number	:	713-574-8916
Fax Number	:	713-574-8917

Provider Business Practice Location Address
First Line	:	7535 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1423
Country	:	US
Telephone Number	:	713-574-8916
Fax Number	:	713-574-8917

Authorized Official
Title or Position	:	CEO
Name	:	MR. TERRY FOX
Credential	:
Telephone Number	:	713-574-8916

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	09/02/2010

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Directions to “BRAESWOOD MEDICAL ” Practice Location

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