Organization
BRAZOSPORT WOMENS HEALTH PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMATHA KADIYALA MD (PHYSICIAN - OWNER)
(979) 266-9544
Entity
Organization
Contact information
Practice address
506 THIS WAY ST, LAKE JACKSON, TX 77566-5128
(979) 266-9544
(979) 529-9737
Mailing address
215 OAK DRIVE SOUTH, SUITE B, LAKE JACKSON, TX 77566-5617
(979) 266-9544
(979) 529-9737
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
N4502
TX
Other
Enumeration date
09/02/2010
Last updated
06/06/2016
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