Individual
DR. ALBERT CHARLES LO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8441 STATE HIGHWAY 47 STE 1400, BRYAN, TX 77807-3208
(979) 774-8200
(877) 607-5854
Mailing address
2900 E 29TH ST, STE 100, BRYAN, TX 77802-2623
(217) 355-0926
(217) 355-1801
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
36-090682
IL
2084P0800X
Psychiatry Physician
Primary
S7091
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01032028
BCBS
IL
01
—
1D7195
MEDICARE
TX
05
—
412995901
—
TX
Enumeration date
09/15/2005
Last updated
01/11/2021
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