Bryan Family Medicine Clinic, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BRYAN FAMILY MEDICINE CLINIC, PA

Practice address

2709 Osler Blvd
Bryan, TX 77802-2518

Phone

(979) 776-2200

NPI assigned

Apr 14, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shailesh Dhaduk, MDNPI 1326047259

Title

President

Phone

(979) 776-2200

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shailesh D Dhaduk, M.D.

  • Family Medicine Physician
  • Bryan, TX
  • NPI 1326047259
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235193483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2709 OSLER BLVD",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022518",
            "telephone_number": "979-776-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2709 OSLER BLVD",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022518",
            "telephone_number": "979-776-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN FAMILY MEDICINE CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DHADUK",
        "authorized_official_first_name": "SHAILESH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "979-776-2200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "0068MY",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jayson Derald Brunette
• Brittany Bruton, O.D.
• Bryan College Station ASC, LP (The Heart and Vascular Surgery Center)
• Bryan Dental Group PLLC
• Bryan Emergency Physicians PA
• Bryan Family Practice PLLC
• Bryan Gastropath, LLC
• Bryan Isd
• Bryan Kidney Center PLLC
• Bryan Medical Associates Medical Association

• Family Medicine Physician in Bryan, TX
• Providers in Bryan, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.