Provider Demographics
NPI:1619287000
Name:BRYAN W HAMBRIC MD PA
Entity Type:Organization
Organization Name:BRYAN W HAMBRIC MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER OF PA
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:HAMBRIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-379-4500
Mailing Address - Street 1:1346 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5126
Mailing Address - Country:US
Mailing Address - Phone:830-379-4500
Mailing Address - Fax:830-379-4501
Practice Address - Street 1:1346 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5126
Practice Address - Country:US
Practice Address - Phone:830-379-4500
Practice Address - Fax:830-379-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0016WAOtherBCBS GROUP ID NUMBERS
TX8CQ121OtherBCBS INDIVIDUAL ID NUMBER
TXTXB116454Medicare PIN
TX0016WAOtherBCBS GROUP ID NUMBERS