Active NPI 1083996177 Individual Practitioner Female Practitioner

Dr. Katherine E Blalock , MD

General Practice • Bryan, TX

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Katherine Blalock, MD is a certified General Practice practicing in Bryan, TX. With approximately 15 years of clinical experience since graduating from Texas A & M University System, Hsc, College Of Medicine in 2011, Dr. Blalock delivers high-quality medical care to the local community at 2900 E 29TH ST STE 200.

Dr. Blalock maintains professional affiliations with Texas Aandm University System Health Science Center, Privia Medical Group Gulf Coast Pllc and accepts Medicare assignment.

Frequently performed procedures and clinical services include subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least, established patient outpatient office visit, visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

2900 E 29th St Ste 200

Bryan, TX 778022623

Telephone 9797768440

Associated Practice Facility / Clinic

🏢 Texas A&m University System Health Science Center Facility NPI 1063699312

Medicare Profile & Education

Medical School

Texas A & M University System, Hsc, College Of Medicine

Graduation Year

2011

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Bryan, TX

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

15 Yrs Matches City Avg

City Avg: 15.0 Yrs

State Avg: 27.9 Yrs

Regional Practice Density

3 Specialists

Practicing in Bryan, TX (1183 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

49.0% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Blalock (15 Years) 15 Yrs

Bryan Specialty Average (15.0 Years) 15.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	544	55	$206.09	$102.38
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	336	149	$246.14	$122.22
G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's	309	152	$32.00	$15.69
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	199	49	$206.11	$102.64
99349 Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes	189	23	$244.40	$121.50
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	159	61	$151.00	$75.08
99238 Hospital discharge day management, 30 minutes or less	61	59	$155.00	$77.12
99306 Initial nursing facility visit, typically 45 minutes per day	39	34	$348.36	$172.97
G0008 Administration of influenza virus vaccine	33	31	$47.00	$31.03
90662 Influenza vaccine split virus, preservative free	32	29	$148.25	$80.89
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	32	16	$227.00	$112.76
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	19	18	$250.00	$124.59
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	18	18	$320.67	$159.64
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	17	16	$331.00	$165.30
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	14	14	$530.00	$290.77
99315 Nursing facility discharge day management, 30 minutes or less	14	13	$156.21	$77.52
G0009 Administration of pneumococcal vaccine	13	13	$33.00	$31.03
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	12	12	$255.83	$126.81
99316 Nursing facility discharge management, more than 30 minutes	12	11	$251.00	$124.82
99306 Initial nursing facility visit, typically 45 minutes per day	11	11	$348.00	$173.99

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	938	92	$203.74	$102.25
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	356	174	$249.26	$122.46
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	232	48	$203.45	$102.33
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	202	68	$152.05	$75.04
99349 Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes	186	30	$248.87	$122.52
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	60	24	$230.30	$114.40
99238 Hospital discharge day management, 30 minutes or less	60	57	$154.83	$76.41
99306 Initial nursing facility visit, typically 45 minutes per day	52	45	$348.08	$175.06
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	36	29	$259.69	$127.83
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	35	35	$324.40	$160.45
99315 Nursing facility discharge day management, 30 minutes or less	29	28	$155.72	$78.21
90662 Influenza vaccine split virus, preservative free	27	27	$151.93	$71.80
G0008 Administration of influenza virus vaccine	25	25	$258.72	$29.51
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	19	19	$345.95	$166.83
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	14	13	$254.00	$124.89
99306 Initial nursing facility visit, typically 45 minutes per day	13	13	$355.00	$174.86
99316 Nursing facility discharge management, more than 30 minutes	12	12	$246.83	$125.93
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	11	11	$349.36	$171.63

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	830	118	$175.45	$87.47
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	340	156	$251.22	$124.13
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	309	58	$175.56	$87.53
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	156	64	$138.26	$68.89
99336 Established patient assisted living visit, typically 40 minutes	129	21	$261.54	$130.07
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	77	39	$133.35	$66.31
99306 Initial nursing facility visit, typically 45 minutes per day	62	58	$319.48	$159.26
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	56	18	$201.57	$99.41
99238 Hospital discharge day management, 30 minutes or less	55	52	$139.25	$69.54
99315 Nursing facility discharge day management, 30 minutes or less	49	49	$140.06	$69.62
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	45	45	$326.04	$162.23
G0008 Administration of influenza virus vaccine	44	43	$130.50	$28.39
90662 Influenza vaccine split virus, preservative free	40	40	$139.75	$68.46
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	38	35	$249.11	$123.84
87804 Detection test by immunoassay with direct visual observation for influenza virus	27	20	$48.56	$16.38
87426 Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus	27	23	$100.00	$43.63
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	15	15	$383.80	$191.61
G0009 Administration of pneumococcal vaccine	14	14	$122.57	$28.55
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	12	12	$261.33	$119.68
99306 Initial nursing facility visit, typically 45 minutes per day	12	12	$319.25	$159.17
81003 Automated urinalysis test	12	11	$5.83	$2.22

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	522	71	$179.26	$88.60
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	333	67	$187.49	$88.55
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	277	127	$250.63	$125.94
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	187	42	$145.36	$67.01
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	120	62	$140.72	$69.40
99336 Established patient assisted living visit, typically 40 minutes	80	12	$265.80	$131.90
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	50	21	$214.24	$100.56
99306 Initial nursing facility visit, typically 45 minutes per day	46	38	$322.30	$162.06
99238 Hospital discharge day management, 30 minutes or less	45	44	$140.27	$68.82
99315 Nursing facility discharge day management, 30 minutes or less	37	36	$152.92	$70.88
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	29	24	$278.34	$126.02
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	23	23	$40.00	$19.64
99306 Initial nursing facility visit, typically 45 minutes per day	21	19	$322.00	$162.02
G0008 Administration of influenza virus vaccine	21	21	$66.00	$16.47
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	19	19	$327.00	$163.99
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	16	16	$388.50	$194.76
91306 Sarscov2 vac 50mcg/0.25ml im	15	15	$0.01	$0.01
0064A Adm sarscov2 50mcg/0.25mlbst	14	14	$68.00	$38.69

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	381	59	$179.78	$90.51
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	300	49	$179.82	$90.55
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	267	39	$137.57	$68.25
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	219	100	$213.32	$106.97
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	89	43	$143.81	$72.12
99213 Established patient office or other outpatient visit, typically 15 minutes	58	40	$147.38	$71.53
99306 Initial nursing facility visit, typically 45 minutes per day	41	32	$329.00	$166.44
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	39	24	$206.00	$104.09
90662 Influenza vaccine split virus, preservative free	36	35	$64.72	$60.64
G0008 Administration of influenza virus vaccine	34	34	$34.38	$16.21
99238 Hospital discharge day management, 30 minutes or less	30	28	$144.80	$72.61
99315 Nursing facility discharge day management, 30 minutes or less	29	26	$145.66	$72.62
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	28	14	$136.36	$68.21
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	25	22	$400.68	$201.78
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	24	24	$324.50	$161.64
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	23	18	$260.74	$128.07
99306 Initial nursing facility visit, typically 45 minutes per day	19	18	$332.79	$165.98
G0009 Administration of pneumococcal vaccine	12	12	$39.17	$16.17

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	533	75	$186.00	$88.72
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	268	104	$222.00	$104.41
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	231	45	$186.00	$88.81
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	188	38	$141.00	$66.68
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	170	84	$148.93	$70.75
99213 Established patient office or other outpatient visit, typically 15 minutes	111	66	$151.00	$69.97
99238 Hospital discharge day management, 30 minutes or less	65	63	$150.00	$70.91
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	61	36	$213.00	$101.20
G0008 Administration of influenza virus vaccine	59	57	$80.00	$15.36
99315 Nursing facility discharge day management, 30 minutes or less	51	47	$150.00	$71.27
90662 Influenza vaccine split virus, preservative free	50	49	$59.00	$53.20
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	47	42	$266.00	$126.44
99306 Initial nursing facility visit, typically 45 minutes per day	43	40	$341.00	$162.12
99318 Nursing facility annual assessment, typically 30 minutes	33	33	$196.00	$93.02
99217 Hospital observation care on day of discharge	28	27	$150.00	$70.93
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	26	23	$413.00	$194.16
81002 Urinalysis, manual test	25	18	$12.00	$3.27
G0009 Administration of pneumococcal vaccine	25	25	$70.00	$15.90
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	23	13	$41.65	$15.28
J1030 Injection, methylprednisolone acetate, 40 mg	21	13	$10.00	$5.95
90670 Pneumococcal vaccine for injection into muscle	15	15	$375.00	$210.35
99220 Hospital observation care, typically 70 minutes	14	14	$379.00	$180.64
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	12	12	$180.00	$110.34
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	12	12	$335.00	$158.96

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	851	90	$181.04	$88.93
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	277	106	$211.50	$102.43
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	215	40	$181.29	$88.99
99310 Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes	160	50	$268.03	$132.32
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	122	69	$143.66	$71.00
99213 Established patient office or other outpatient visit, typically 15 minutes	95	67	$143.23	$69.62
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	77	47	$206.61	$101.72
G0008 Administration of influenza virus vaccine	61	60	$61.97	$19.19
99238 Hospital discharge day management, 30 minutes or less	60	57	$144.35	$71.20
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	55	53	$259.33	$127.05
90662 Influenza vaccine split virus, preservative free	54	53	$49.93	$48.02
G0181 Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow	52	16	$211.00	$104.87
99315 Nursing facility discharge day management, 30 minutes or less	48	45	$144.96	$70.86
99306 Initial nursing facility visit, typically 45 minutes per day	45	42	$329.02	$162.63
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	37	37	$401.86	$197.81
J1030 Injection, methylprednisolone acetate, 40 mg	37	16	$10.00	$6.19
G0009 Administration of pneumococcal vaccine	25	25	$70.00	$19.51
99217 Hospital observation care on day of discharge	22	22	$144.18	$71.29
99318 Nursing facility annual assessment, typically 30 minutes	21	21	$189.00	$93.83
99225 Subsequent observation care, typically 25 minutes per day	17	12	$146.53	$71.38
81002 Urinalysis, manual test	17	15	$12.00	$3.21
99220 Hospital observation care, typically 70 minutes	16	16	$367.38	$181.84
G0442 Annual alcohol misuse screening, 5 to 15 minutes	16	16	$35.00	$17.55
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	13	13	$160.00	$51.73
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	13	13	$180.00	$105.59
90670 Pneumococcal vaccine for injection into muscle	12	12	$343.75	$181.21
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	12	12	$321.67	$159.38

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	763	91	$178.00	$87.95
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	225	89	$207.00	$102.62
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	185	87	$142.00	$69.81
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	174	42	$178.00	$88.19
99213 Established patient office or other outpatient visit, typically 15 minutes	125	61	$141.00	$69.88
99238 Hospital discharge day management, 30 minutes or less	76	73	$142.00	$70.14
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	68	26	$135.00	$66.70
99310 Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes	67	31	$264.00	$131.26
G0181 Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow	63	16	$209.86	$103.89
99306 Initial nursing facility visit, typically 45 minutes per day	50	44	$325.00	$161.42
G0008 Administration of influenza virus vaccine	49	47	$57.14	$23.91
99315 Nursing facility discharge day management, 30 minutes or less	44	41	$143.00	$70.82
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	39	26	$204.00	$99.43
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	38	38	$255.00	$123.43
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	33	32	$397.00	$196.70
90662 Influenza vaccine split virus, preservative free	32	32	$46.94	$44.79
J1030 Injection, methylprednisolone acetate, 40 mg	25	15	$9.76	$5.59
G0009 Administration of pneumococcal vaccine	23	23	$66.09	$23.91
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	22	18	$48.00	$24.10
90670 Pneumococcal vaccine for injection into muscle	22	22	$375.00	$185.69
90688 Vaccine for influenza for administration into muscle, 0.5 ml dosage	19	19	$30.00	$17.48
81002 Urinalysis, manual test	16	13	$12.00	$3.22
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	15	11	$110.00	$39.39
99496 Transitional care management services for problem of high complexity	14	12	$318.00	$220.74
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	13	12	$160.00	$51.34
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	13	13	$208.00	$103.42
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	11	11	$319.00	$157.29

Medical Specialties & State Licenses

CMS Verified: 2026-07-15

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License TX Q0874

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Family Medicine

NUCC Taxonomy Code: 207Q00000X

State License TX Q0874

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Family Medicine

NUCC Taxonomy Code: 207Q00000X

State License TX 0040277

Hospital & Practice Group Affiliations

Privia Medical Group Gulf Coast Pllc

7900 Fannin St, Houston, TX 770542935

Phone: 7135127500

Texas Aandm University System Health Science Center

2900 E 29th St, Bryan, TX 778022623

Phone: 9797768440

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

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Family Medicine

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Doctor of Medicine (M.D.)

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Doctor of Osteopathic Medicine (D.O.)

Dr. Amy Waer , MD

Surgery

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Doctor of Medicine (M.D.)

Dr. Camille Merhi , MD

Psychiatry & Neurology - Psychiatry

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Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 15, 2026

Family Medicine (License #Q0874 in TX)

📍

Updated Business Mailing Address July 15, 2020

Registered at 2900 E 29TH ST STE 100, BRYAN, TX 778022623 (Tel: 9797768440)

✅

NPI Profile Active September 14, 2011

NPI status registered as active in NPPES database

📍

Updated Practice Location September 14, 2011

Registered at 2900 E 29TH ST STE 200, BRYAN, TX 778022623 (Tel: 9797768440)

📍

Updated Business Mailing Address September 14, 2011

Registered at 2900 E 29TH ST STE 200, BRYAN, TX 778022623 (Tel: 9797768440)

👤

Provider Name / Credentials Updated September 14, 2011

Recorded as KATHERINE BLALOCK, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) September 14, 2011

Family Medicine (License #0040277 in TX)

🟢

Initial NPI Registration & Enumeration September 14, 2011

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1083996177

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: September 14, 2011

Last Update: July 15, 2026

Sole Proprietor: No

Update or Correct Profile

Mailing Address

2900 E 29th St Ste 100

Bryan, TX 778022623

Phone: 9797768440

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.