Organization
BERT C. BRYAN M.D. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERT C. BRYAN M.D. (OWNER)
(214) 369-8478
Entity
Organization
Contact information
Practice address
8210 WALNUT HILL LN, SUITE 100 LB-5, DALLAS, TX 75231-4405
(214) 369-8478
(214) 696-1594
Mailing address
8210 WALNUT HILL LN, SUITE 100 LB-5, DALLAS, TX 75231-4418
(214) 369-8478
(214) 696-1594
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
D3765
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A5543
MEDICARE PTAN
TX
01
—
D3765
MEDICAL LICENSE
TX
Enumeration date
11/20/2009
Last updated
12/08/2010
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