Provider Demographics
NPI:1992197388
Name:BRYANT, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BRYANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BARTON SPRINGS RD UNIT 3041
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-1483
Mailing Address - Country:US
Mailing Address - Phone:512-497-6487
Mailing Address - Fax:
Practice Address - Street 1:1900 BARTON SPRINGS RD UNIT 3041
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-1483
Practice Address - Country:US
Practice Address - Phone:512-497-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor