Organization
BRAZOSPORT PEDIATRIC AND FAMILY CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN DEANN KING (OWNER)
(979) 300-0032
Entity
Organization
Contact information
Practice address
222 N VELASCO ST STE A, ANGLETON, TX 77515-4576
(979) 300-0032
(979) 297-9096
Mailing address
222 N VELASCO ST STE A, ANGLETON, TX 77515-4576
(979) 300-0032
(979) 297-9096
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1457645806
NPI
TX
01
—
1740052984
NPI
TX
Enumeration date
07/08/2019
Last updated
01/23/2024
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