Provider Demographics
NPI:1598320855
Name:STEPHENS, BRYAN (DO)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:STEPHENS
Suffix:
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 1:921 S SAVAGE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:BROCK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-4061
Mailing Address - Country:US
Mailing Address - Phone:817-727-2735
Mailing Address - Fax:
Practice Address - Street 1:6302 LAKE WORTH BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3607
Practice Address - Country:US
Practice Address - Phone:817-237-8273
Practice Address - Fax:817-237-0374
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT7745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine