Provider Demographics
NPI:1922119890
Name:VAILLANT, BRIAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:VAILLANT
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 1:900 E 30TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3326
Mailing Address - Country:US
Mailing Address - Phone:512-505-5500
Mailing Address - Fax:512-334-2702
Practice Address - Street 1:900 E 30TH ST
Practice Address - Street 2:STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3326
Practice Address - Country:US
Practice Address - Phone:512-334-2777
Practice Address - Fax:512-334-2702
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN19342084N0400X
WAML200077912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280334806Medicaid
TX280334802Medicaid
TX280334804Medicaid
TX280334805Medicaid
TX390776YN56Medicare PIN
TXTXB156124Medicare PIN
TX390776YN57Medicare PIN