Organization
FAMILY PRACTICE FOUNDATION OF THE BRAZOS VALLEY
Active
Parent organization
FAMILY PRACTICE FOUNDATION OF THE BRAZOS VALLEY
Other names
Family Medicine Center & Brazos Family Medicine Residency
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAMILY PRACTICE FOUNDATION OF THE BRAZOS VALLEY
Authorized official
DR. DAVID A MCCLELLAN M.D. (PROGRAM DIRECTOR)
(979) 862-4465
Entity
Organization
Contact information
Practice address
1301 MEMORIAL DRIVE, SUITE 200, BRYAN, TX 77802-5201
(979) 862-4465
(979) 774-6603
Mailing address
1301 MEMORIAL DRIVE, SUITE 200, BRYAN, TX 77802-5201
(979) 862-4465
(979) 774-6603
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M2390
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111967901
—
TX
Enumeration date
08/09/2006
Last updated
08/05/2008
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