Provider Demographics
NPI:1275516791
Name:FAMILY PRACTICE ASSOCIATES OF ANGLETON
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF ANGLETON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:VESELKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-849-6467
Mailing Address - Street 1:136 E HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-4161
Mailing Address - Country:US
Mailing Address - Phone:979-849-6467
Mailing Address - Fax:
Practice Address - Street 1:136 E HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4161
Practice Address - Country:US
Practice Address - Phone:979-849-6467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCS5504OtherMEDICARE RAILROAD
TXCS5504OtherMEDICARE RAILROAD