Brazosport Urology, PA

NPI #1417177270 in Lake Jackson, Texas

Provider Information

NPI Number: 1417177270
Entity Type: Organization
Organization Name: Brazosport Urology, PA
Primary Specialty: Urology
Enumeration Date: Apr 26, 2007
Last Updated: Jun 23, 2008

Practice Location

Address: 115 ABNER JACKSON PKWY
Address 2: SUITE C
City: Lake Jackson
State: Texas
ZIP Code: 77566-5157
Phone: (979) 297-4140

Authorized Official

Name: MR. DERRICK ANTHONY BERGER
Title: PRACTICE MANAGER
Phone: (979) 297-4140

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Urology	208800000X	Primary

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