Provider Demographics
NPI:1770372237
Name:YOUNG, BRYANT (LAT)
Entity type:Individual
Prefix:
First Name:BRYANT
Middle Name:
Last Name:YOUNG
Suffix:
Gender:
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9712 RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5614
Mailing Address - Country:US
Mailing Address - Phone:817-566-6385
Mailing Address - Fax:
Practice Address - Street 1:9712 RANCHO DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5614
Practice Address - Country:US
Practice Address - Phone:817-566-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT10051207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine