Provider Demographics
NPI:1659442234
Name:AUSTIN, BRYAN JOSEPH (DME)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:JOSEPH
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:DME
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 3609
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75106-3609
Mailing Address - Country:US
Mailing Address - Phone:214-902-0040
Mailing Address - Fax:214-902-0220
Practice Address - Street 1:2639 WALNUT HILL LN
Practice Address - Street 2:SUITE#160-B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-5640
Practice Address - Country:US
Practice Address - Phone:214-902-0040
Practice Address - Fax:214-902-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5106480001Medicare ID - Type UnspecifiedMEDICARE