Individual
DR. BRIAN A WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
407 W DANIELDALE RD # 100, DUNCANVILLE, TX 75137-3927
(214) 941-3192
Mailing address
504 N REO ST, TAMPA, FL 33609-1013
(813) 549-2134
(813) 864-4436
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ME102576
TX
207Q00000X
Family Medicine Physician
Primary
R0343
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000433500
—
TX
01
—
30675
BCBS OF FLORIDA
TX
01
—
AS713Y
MEDICARE UPIN
TX
01
—
P00811430
RAILROAD MEDICARE
TX
Enumeration date
09/22/2008
Last updated
02/19/2020
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