Individual
JONATHON BRYCE-EDWARD OLENCZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
P O BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
R5912
TX
208200000X
Plastic Surgery Physician
R5912
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
387485101
—
TX
01
—
387485102
MEDICAID CSHCN
TX
Enumeration date
04/19/2012
Last updated
02/07/2021
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