Provider Demographics
NPI:1740695824
Name:BOURLAND, BRYAN (DO)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:BOURLAND
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 1:301 UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3111
Mailing Address - Country:US
Mailing Address - Phone:806-797-4985
Mailing Address - Fax:806-792-8588
Practice Address - Street 1:301 UTICA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3111
Practice Address - Country:US
Practice Address - Phone:806-797-4985
Practice Address - Fax:806-792-8588
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021223207X00000X
TXS7395207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery