Provider Demographics
NPI:1063667509
Name:JANSSEN, BRYAN LEE (MD)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:LEE
Last Name:JANSSEN
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 1:2710 HOSPITAL DR STE 112
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5743
Mailing Address - Country:US
Mailing Address - Phone:361-582-1137
Mailing Address - Fax:361-573-5042
Practice Address - Street 1:2710 HOSPITAL DR STE 112
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5743
Practice Address - Country:US
Practice Address - Phone:361-582-1137
Practice Address - Fax:361-573-5042
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10032146390200000X
TXP5387207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program