Individual
DR. MICHAEL DENNIS BRYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
660 W SOUTHLAKE BLVD, SUITE 100, SOUTHLAKE, TX 76092-6003
(817) 416-9731
(817) 416-9751
Mailing address
660 W SOUTHLAKE BLVD, SUITE 100, SOUTHLAKE, TX 76092-6003
(817) 416-9731
(817) 416-9751
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
J1503
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0052ET
BCBS
TX
05
—
113601203
—
TX
01
—
5675166
AETNA
TX
Enumeration date
02/15/2006
Last updated
07/09/2012
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