Provider Demographics
NPI:1386026367
Name:UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
Entity Type:Organization
Organization Name:UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REISER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-772-1909
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:ROUTE 0115
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0115
Mailing Address - Country:US
Mailing Address - Phone:409-747-8783
Mailing Address - Fax:
Practice Address - Street 1:2240 GULF FWY S
Practice Address - Street 2:PHARMACY ROOM 2.203
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5143
Practice Address - Country:US
Practice Address - Phone:832-505-3172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1300363336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0999480003Medicare NSC