Individual
SIDNEY E O'BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-3627
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
32949
TX
103T00000X
Psychologist
Primary
32949
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147255100
TEAMCHOICE/FIRSTCARE
TX
05
—
181392506
—
TX
05
—
200081980A
—
OK
01
—
202001080
PRESBYTERIAN COMMERCIAL
NM
05
—
202001080
—
NM
01
—
88547A
BCBS
TX
Enumeration date
06/24/2006
Last updated
10/22/2012
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