Provider Demographics
NPI:1700176773
Name:THOMAS, BRYAN MATHEW (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:MATHEW
Last Name:THOMAS
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 1:2022 RIVA RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1143
Mailing Address - Country:US
Mailing Address - Phone:248-763-2161
Mailing Address - Fax:
Practice Address - Street 1:2022 RIVA RIDGE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-1143
Practice Address - Country:US
Practice Address - Phone:248-763-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4119207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine