Provider Demographics
NPI:1558665117
Name:BRYAN, VIVIENNE ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:ELAINE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 WAGNER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3719
Mailing Address - Country:US
Mailing Address - Phone:713-868-3301
Mailing Address - Fax:713-868-4817
Practice Address - Street 1:1234 WAGNER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3719
Practice Address - Country:US
Practice Address - Phone:713-868-3301
Practice Address - Fax:713-868-4817
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8030208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
84V169Medicare UPIN