BRAZOSPORT RADIOLOGY PLLC NPI 1497970669

NPI Information

  • NPI: 1497970669
  • Provider Name: BRAZOSPORT RADIOLOGY PLLC
  • Classification: Radiology - 2085R0202X
  • Specialization: Diagnostic Radiology
  • Entity Type: Organization
  • Address: 100 MEDICAL DR
    LAKE JACKSON, TX
    ZIP 77566
  • Phone: (979) 285-1937

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NPI Details

BRAZOSPORT RADIOLOGY PLLC is a diagnostic radiology radiology in Lake Jackson, TX. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. BRAZOSPORT RADIOLOGY PLLC NPI is 1497970669. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

100 MEDICAL DR
LAKE JACKSON, TX
ZIP 77566-674
Phone: (979) 285-1937

The provider's authorized official is Craig Freedman .
The authorized official title is President and has the following contact phone number (979) 285-1937.

The enumeration date for this NPI number is 4/14/2007 and was last updated on 6/15/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12085R0202XRadiologyDiagnostic RadiologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1DO3043OTHERTEXASRR MEDICARE
2196064301MEDICAIDTEXAS
300Y662MEDICARE PINTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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