Brazos Primary Care Associates | |
201 Oak Dr S Suite 102 Lake Jackson TX 77566-5676 | |
(979) 266-9776 | |
(979) 529-2952 |
Full Name | Brazos Primary Care Associates |
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Speciality | Clinic/Center |
Location | 201 Oak Dr S, Lake Jackson, Texas |
Authorized Official Name and Position | Frank Okosun (MEDICAL DIRECTOR) |
Authorized Official Contact | 9792669776 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Brazos Primary Care Associates 201 Oak Dr S Suite 102 Lake Jackson TX 77566-5676 Ph: (979) 266-9776 | Brazos Primary Care Associates 201 Oak Dr S Suite 102 Lake Jackson TX 77566-5676 Ph: (979) 266-9776 |
NPI Number | 1366812760 |
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Provider Enumeration Date | 09/29/2015 |
Last Update Date | 09/29/2015 |
Medicare PECOS PAC ID | 4082924956 |
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Medicare Enrollment ID | O20151104001898 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366812760 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | P7174 (Texas) | Primary |
Provider Name | Frank E Okosun |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1093027807 PECOS PAC ID: 0648404798 Enrollment ID: I20131004000074 |
Provider Name | Stellamaris Irabor |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699104661 PECOS PAC ID: 5193954089 Enrollment ID: I20140219001499 |
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