Provider Demographics
NPI:1033312749
Name:ARMIJO, BRYAN STAPP (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:STAPP
Last Name:ARMIJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 N CENTRAL EXPY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5956
Mailing Address - Country:US
Mailing Address - Phone:214-540-1434
Mailing Address - Fax:469-375-3823
Practice Address - Street 1:9101 N CENTRAL EXPY STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5956
Practice Address - Country:US
Practice Address - Phone:214-540-1434
Practice Address - Fax:469-375-3823
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57011772208200000X
TXN8482282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH51354OtherRESIDENT ID #