Provider Demographics
NPI:1902856800
Name:BRIAN, MARY BELVA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BELVA
Last Name:BRIAN
Suffix:
Gender:F
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1615 HOSPITAL PKWY
Practice Address - Street 2:SUITE 109
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5934
Practice Address - Country:US
Practice Address - Phone:817-662-0008
Practice Address - Fax:817-391-0030
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2110174400000X, 208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098287804Medicaid
TX098287805Medicaid
TX098287803Medicaid
TX8G1590OtherBCBS
TX8K4764Medicare PIN
TX8G1590OtherBCBS
TX098287804Medicaid
TXC4480Medicare UPIN
TX098287805Medicaid
TXP00471000Medicare PIN