Provider Demographics
NPI:1225085822
Name:DEMARIE, BRYAN KEITH (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:KEITH
Last Name:DEMARIE
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 1:6750 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2875
Mailing Address - Country:US
Mailing Address - Phone:972-556-1616
Mailing Address - Fax:972-556-1740
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2875
Practice Address - Country:US
Practice Address - Phone:972-556-1616
Practice Address - Fax:972-556-1740
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042740304Medicaid
TX042740305OtherMEDICAID OTHER
TX042740302Medicaid
TX042740303Medicaid
TX352133YL7AOtherMEDICARE - OTHER COUNTY
TX042740302Medicaid
TXTXB144601OtherMEDICARE/TARRANT COUNTY
TX8B1000Medicare PIN
TXF34725Medicare UPIN