Provider Demographics
NPI:1679764286
Name:BRYAN H. MINTON, MD, PA
Entity Type:Organization
Organization Name:BRYAN H. MINTON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR.
Authorized Official - Prefix:
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-221-3924
Mailing Address - Street 1:PO BOX 844128
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284
Mailing Address - Country:US
Mailing Address - Phone:972-860-8648
Mailing Address - Fax:
Practice Address - Street 1:1422 W MAIN ST
Practice Address - Street 2:SUITE 100A
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3387
Practice Address - Country:US
Practice Address - Phone:972-221-3924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH TEXAS PROVIDER NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-08
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152189002Medicaid
TX470855656OtherTAX INDENTIFIER NUMBER
TX009QPOtherBCBSTX
DC1194OtherRAILROAD MEDICARE, GROUP
TX00348TMedicare PIN