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Organization
STEVENS PARK CLINIC MEDICAL GROUP
Active
Organization
STEVENS PARK CLINIC MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN M BRYANT D.O. (OWNER)
(214) 943-4631
Entity
Organization
Contact information
Practice address
2100 W COLORADO BLVD, DALLAS, TX 75211-1900
(214) 943-4631
(214) 946-5334
Mailing address
2100 W COLORADO BLVD, DALLAS, TX 75211-1900
(214) 943-4631
(214) 946-5334
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K2425
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00500R
MEDICARE PTAN
TX
05
—
144698103
—
TX
Enumeration date
06/05/2007
Last updated
03/02/2015
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