Organization
BRAZOSPORT RADIOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG FREEDMAN M.D. (PRESIDENT)
(979) 285-1937
Entity
Organization
Contact information
Practice address
100 MEDICAL DR, LAKE JACKSON, TX 77566-5674
(979) 285-1937
Mailing address
PO BOX 1547, SEDALIA, MO 65302-1547
(660) 826-5960
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196064301
—
TX
01
—
DO3043
RR MEDICARE
TX
Enumeration date
04/14/2007
Last updated
06/15/2011
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