Individual
DR. BRENDA THARIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
129 VISION PARK BLVD STE 301, SHENANDOAH, TX 77384-3024
(936) 647-2184
(936) 647-2201
Mailing address
129 VISION PARK BLVD STE 301, SHENANDOAH, TX 77384-3024
(936) 647-2184
(936) 647-2201
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
N6066
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP10023442
BASIC PERMIT
TX
01
—
N6066
TEXAS MEDICAL LICENSE
TX
01
—
P01029717
RAILROAD MEDICARE
TX
Enumeration date
03/29/2010
Last updated
01/22/2018
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