Provider Demographics
NPI:1861491995
Name:MINTON, BRYAN H (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:H
Last Name:MINTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 PARKER SQ
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7432
Mailing Address - Country:US
Mailing Address - Phone:972-724-1707
Mailing Address - Fax:972-724-1407
Practice Address - Street 1:1110 PARKER SQ
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7432
Practice Address - Country:US
Practice Address - Phone:972-724-1707
Practice Address - Fax:972-724-1407
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152190806Medicaid
TX152190805Medicaid
TX8BC051OtherBCBSTX
TX152190805Medicaid
TXTXB133388Medicare PIN
TXTXB117724Medicare PIN