Provider Demographics
NPI:1114014248
Name:YOUREE, BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:YOUREE
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:PO BOX 162464
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-2464
Mailing Address - Country:US
Mailing Address - Phone:817-810-9810
Mailing Address - Fax:817-810-9815
Practice Address - Street 1:1025 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3013
Practice Address - Country:US
Practice Address - Phone:817-810-9810
Practice Address - Fax:817-810-9815
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4674207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J8303OtherBLUE CROSS BLUE SHIELD
TX184244501Medicaid
TXM4674OtherTEXAS LICENSE
TXM4674OtherTEXAS LICENSE
TX184244501Medicaid