Provider Demographics
NPI:1508905837
Name:KAHL, BRYAN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:MARTIN
Last Name:KAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-416-6010
Mailing Address - Fax:
Practice Address - Street 1:5012 S US HIGHWAY 75
Practice Address - Street 2:SUITE 300
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4587
Practice Address - Country:US
Practice Address - Phone:903-416-6010
Practice Address - Fax:903-416-6183
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6513207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198257101Medicaid
TXP00675408OtherRR MEDICARE
TXP00675408OtherRR MEDICARE
TX198257101Medicaid