Provider Demographics
NPI:1841240272
Name:BRYAN NEUROLOGY SERVICES, P.A.
Entity Type:Organization
Organization Name:BRYAN NEUROLOGY SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-693-1931
Mailing Address - Street 1:PO BOX 10102
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-0102
Mailing Address - Country:US
Mailing Address - Phone:979-693-1931
Mailing Address - Fax:
Practice Address - Street 1:2100 BENT OAK ST
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5585
Practice Address - Country:US
Practice Address - Phone:979-693-1931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty