Provider Demographics
NPI:1275134199
Name:MEDICAL GROUP OF TEXAS PLLC
Entity Type:Organization
Organization Name:MEDICAL GROUP OF TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BROUWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-249-0999
Mailing Address - Street 1:825 WATTERS CREEK BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3770
Mailing Address - Country:US
Mailing Address - Phone:918-550-3552
Mailing Address - Fax:
Practice Address - Street 1:825 WATTERS CREEK BLVD STE 250
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3770
Practice Address - Country:US
Practice Address - Phone:918-550-3552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL GROUP OF TEXAS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-06
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment