Provider Demographics
NPI:1689388647
Name:COLLIER, BRYAN JAMES
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JAMES
Last Name:COLLIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 GLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2927
Mailing Address - Country:US
Mailing Address - Phone:940-642-8139
Mailing Address - Fax:
Practice Address - Street 1:3410 TAFT BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2096
Practice Address - Country:US
Practice Address - Phone:940-397-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program