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Organization
GULFSIDE MEDICAL CLINIC OF TEXAS, PA
Active
Organization
GULFSIDE MEDICAL CLINIC OF TEXAS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK H BRACKIN M.D. (OWNER / PHYSICIAN)
(361) 729-9811
Entity
Organization
Contact information
Practice address
1209 HIGHWAY 35 N, SUITE A, ROCKPORT, TX 78382-3117
(361) 729-9811
(361) 729-9819
Mailing address
1209 HIGHWAY 35 N, SUITE A, ROCKPORT, TX 78382-3117
(361) 729-9811
(361) 729-9819
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J0446
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0025PW
BCBS GROUP NUMBER
TX
Enumeration date
08/07/2006
Last updated
11/19/2007
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