Brazos Wound Associates, PA

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

L0167 Issued in TX

Legal business name

BRAZOS WOUND ASSOCIATES, PA

Practice address

1605 Rock Prairie Rd
Suite 102
College Station, TX 77845-8358

Phone

(979) 764-4325

Fax

(979) 764-4345

NPI assigned

Apr 16, 2007

Last updated

Apr 30, 2015By 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

Hugh M Tadlock, MDNPI 1639132327

Title

Owner

Phone

(512) 508-1809

Specialties & licenses 1

Addresses

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.

• Hugh M Tadlock, M.D.

  • Internal Medicine Physician
  • College Station, TX
  • NPI 1639132327
  Authorized official Same address or phone

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430352000000",
    "number": "1578788519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4063",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778054063",
            "telephone_number": "979-764-4325",
            "fax_number": "979-764-4345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 ROCK PRAIRIE RD",
            "address_2": "SUITE 102",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458358",
            "telephone_number": "979-764-4325",
            "fax_number": "979-764-4345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAZOS WOUND ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2015-04-30",
        "status": "A",
        "authorized_official_last_name": "TADLOCK",
        "authorized_official_first_name": "HUGH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-508-1809",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "L0167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in College Station, TX
• Providers in College Station, TX by specialty
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.