Provider Demographics
NPI:1528029485
Name:BRYAN, VANCE WINBURN JR (MD)
Entity Type:Individual
Prefix:
First Name:VANCE
Middle Name:WINBURN
Last Name:BRYAN
Suffix:JR
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:PO BOX 744127
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-4127
Mailing Address - Country:US
Mailing Address - Phone:214-345-7280
Mailing Address - Fax:214-345-4487
Practice Address - Street 1:8200 WALNUT HILL LANE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4402
Practice Address - Country:US
Practice Address - Phone:214-345-7280
Practice Address - Fax:214-345-4487
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2488207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E85593Medicare UPIN
TX83P871Medicare PIN