Provider Demographics
NPI:1306802384
Name:UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
Entity type:Organization
Organization Name:UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REISER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-772-1909
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:RT 0115
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0115
Mailing Address - Country:US
Mailing Address - Phone:409-747-8783
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:CSW 7TH FLOOR
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0401
Practice Address - Country:US
Practice Address - Phone:409-772-1175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161988401Medicaid
TX161988401Medicaid