Organization
BRAZOSPORT PEDIATRIC CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD A HARDOIN M.D. (PRESIDENT)
(979) 297-5066
Entity
Organization
Contact information
Practice address
54 FLAG LAKE PLZ, LAKE JACKSON, TX 77566-6263
(979) 297-5066
(979) 297-9096
Mailing address
54 FLAG LAKE PLZ, LAKE JACKSON, TX 77566-6263
(979) 297-5066
(979) 297-9096
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
07/29/2006
Last updated
08/22/2020
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