| NPI | 1124269840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN JOSEPH GOERIG Provider 979-543-3738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L7619) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L7619) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX L7619) | |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2009-07-29 |