Provider Demographics
NPI:1376902650
Name:GULF COAST MEDICAL EVALUATIONS
Entity Type:Organization
Organization Name:GULF COAST MEDICAL EVALUATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-754-7397
Mailing Address - Street 1:6840 FM 2354 RD
Mailing Address - Street 2:
Mailing Address - City:BEACH CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77523-9191
Mailing Address - Country:US
Mailing Address - Phone:832-754-7397
Mailing Address - Fax:
Practice Address - Street 1:2620 CULLEN BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-8961
Practice Address - Country:US
Practice Address - Phone:832-754-7397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5849TX111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Single Specialty