Provider Demographics
NPI:1467509919
Name:BRAZORIA NEUROLOGICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:BRAZORIA NEUROLOGICAL ASSOCIATES, P.A.
Other - Org Name:BRAZORIA NEUROLOGICAL ASSOCIATES, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-299-3376
Mailing Address - Street 1:214 PARKING WAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5227
Mailing Address - Country:US
Mailing Address - Phone:979-299-3376
Mailing Address - Fax:979-299-3197
Practice Address - Street 1:214 PARKING WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5227
Practice Address - Country:US
Practice Address - Phone:979-299-3376
Practice Address - Fax:979-299-3197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty