Provider Demographics
NPI:1437499571
Name:BRAZOS SPINE PC
Entity Type:Organization
Organization Name:BRAZOS SPINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUKUND
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-693-1815
Mailing Address - Street 1:1602 ROCK PRAIRIE ROAD
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845
Mailing Address - Country:US
Mailing Address - Phone:979-693-1815
Mailing Address - Fax:979-693-4706
Practice Address - Street 1:1602 ROCK PRAIRIE ROAD
Practice Address - Street 2:SUITE 2400
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845
Practice Address - Country:US
Practice Address - Phone:979-693-1815
Practice Address - Fax:979-693-4706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8709207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty