Provider Demographics
NPI:1538937131
Name:BRAZOS VALLEY COLORECTAL SURGERY, PLLC
Entity type:Organization
Organization Name:BRAZOS VALLEY COLORECTAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CANNON
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-315-8121
Mailing Address - Street 1:6601 FM 594 RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:TX
Mailing Address - Zip Code:77835-5777
Mailing Address - Country:US
Mailing Address - Phone:210-305-9058
Mailing Address - Fax:
Practice Address - Street 1:3201 UNIVERSITY DR E
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3475
Practice Address - Country:US
Practice Address - Phone:979-315-8121
Practice Address - Fax:855-592-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty