Provider Demographics
NPI:1164420204
Name:BEHNE, BRYAN K (M D)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:K
Last Name:BEHNE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 PINECROFT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3880
Mailing Address - Country:US
Mailing Address - Phone:281-367-6836
Mailing Address - Fax:281-367-5545
Practice Address - Street 1:9180 PINECROFT DR STE 100
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-367-6836
Practice Address - Fax:281-367-5545
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0350174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J1226OtherBCBS
TXI28236Medicare UPIN
TX8J1226OtherBCBS