Basic Information
| Provider Information | |||||||||
| NPI: | 1285717926 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAY AREA PATHOLOGY CONSULTANTS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 714 FM 1960 RD W STE 206 | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770903408 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4600 E SAM HOUSTON PKWY S | ||||||||
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| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775053948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818806991 | ||||||||
| FaxNumber: | 2818806994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 03/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | BRUNNEMANN | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2818806991 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.