Provider Demographics
NPI:1518134154
Name:GAMMON, BRYAN L (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:L
Last Name:GAMMON
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 1:4131 DIRECTORS ROW
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-8703
Mailing Address - Country:US
Mailing Address - Phone:877-697-2447
Mailing Address - Fax:855-697-2447
Practice Address - Street 1:4131 DIRECTORS ROW
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8703
Practice Address - Country:US
Practice Address - Phone:877-697-2447
Practice Address - Fax:855-697-2447
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0862207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology