Organization
COLLEGE STREET MEDICAL GROUP, P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BODRE RISING (PROVIDER/OWNER)
(409) 840-9300
Entity
Organization
Contact information
Practice address
5755 COLLEGE ST, BEAUMONT, TX 77707-3518
(409) 840-9300
(409) 842-4960
Mailing address
5755 COLLEGE ST, BEAUMONT, TX 77707-3518
(409) 840-9300
(409) 842-4960
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
10/21/2009
Last updated
04/28/2011
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