Provider Demographics
NPI:1972537801
Name:WASSON, BRYAN LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LEE
Last Name:WASSON
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 1:2560 CENTRAL PARK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1566
Mailing Address - Country:US
Mailing Address - Phone:972-410-3803
Mailing Address - Fax:972-556-2328
Practice Address - Street 1:2560 CENTRAL PARK AVE STE 140
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1566
Practice Address - Country:US
Practice Address - Phone:972-410-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4780207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121035302Medicaid
TX83Y172OtherBCBS
TX83Y172OtherBCBS
TX110118890Medicare PIN
E92367Medicare UPIN