Provider Demographics
NPI:1437598877
Name:ADUDDELL, BRYAN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:PATRICK
Last Name:ADUDDELL
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 1:1300 MEDICAL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7793
Mailing Address - Country:US
Mailing Address - Phone:972-598-9900
Mailing Address - Fax:972-599-0742
Practice Address - Street 1:1300 MEDICAL AVE STE 102
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7793
Practice Address - Country:US
Practice Address - Phone:972-598-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7369207L00000X, 207LP2900X
CAA147457207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology