Provider Demographics
NPI:1568435774
Name:BRAZOS RADIATION ONCOLOGY, P.A.
Entity Type:Organization
Organization Name:BRAZOS RADIATION ONCOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCHLICHTEMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-774-0808
Mailing Address - Street 1:PO BOX 2289
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-8289
Mailing Address - Country:US
Mailing Address - Phone:972-745-1429
Mailing Address - Fax:972-393-4975
Practice Address - Street 1:2215 E VILLA MARIA RD
Practice Address - Street 2:SUITE 130
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2548
Practice Address - Country:US
Practice Address - Phone:979-774-0808
Practice Address - Fax:979-776-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81701701Medicaid
TX81701701Medicaid