Organization
BRYAN FAMILY MEDICINE CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAILESH DHADUK MD (PRESIDENT)
(979) 776-2200
Entity
Organization
Contact information
Practice address
2709 OSLER BLVD, BRYAN, TX 77802-2518
(979) 776-2200
Mailing address
2709 OSLER BLVD, BRYAN, TX 77802-2518
(979) 776-2200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0068MY
BCBS OF TEXAS
TX
Enumeration date
04/14/2006
Last updated
08/22/2020
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