Provider Demographics
NPI:1487655353
Name:BRYWKA, MICHAEL III (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BRYWKA
Suffix:III
Gender:M
Credentials:DO
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 3899
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79923-3899
Mailing Address - Country:US
Mailing Address - Phone:915-577-0030
Mailing Address - Fax:915-533-2568
Practice Address - Street 1:415 E YANDELL DR
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5208
Practice Address - Country:US
Practice Address - Phone:915-577-0030
Practice Address - Fax:915-533-2568
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8292207L00000X
MDMD21921207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL0133450OtherDPS
TX168837601Medicaid
TX8C8315Medicare ID - Type Unspecified
BB8760060OtherDEA