Provider Demographics
NPI:1952346637
Name:BRAZOS VALLEY ENDOCRINOLOGY PA
Entity Type:Organization
Organization Name:BRAZOS VALLEY ENDOCRINOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DOULGAS
Authorized Official - Last Name:CRUMPLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:979-776-0200
Mailing Address - Street 1:2308 EAST VILLA MARIA
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802
Mailing Address - Country:US
Mailing Address - Phone:979-776-0200
Mailing Address - Fax:979-776-0400
Practice Address - Street 1:2308 EAST VILLA MARIA
Practice Address - Street 2:SUITE 100
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802
Practice Address - Country:US
Practice Address - Phone:979-776-0200
Practice Address - Fax:979-776-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1739724Medicaid
TX1739724Medicaid
I31932Medicare UPIN