Provider Demographics
NPI:1811963507
Name:BRYAN, MARY ANNE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 VETERANS BOULEVARD
Mailing Address - Street 2:WEST TEXAS VA HEALTH CARE SYSTEM
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720
Mailing Address - Country:US
Mailing Address - Phone:432-263-7361
Mailing Address - Fax:432-268-5044
Practice Address - Street 1:300 VETERANS BOULEVARD
Practice Address - Street 2:WEST TEXAS VA HEALTH CARE SYSTEM
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720
Practice Address - Country:US
Practice Address - Phone:432-263-7361
Practice Address - Fax:432-268-5044
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9026207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09705294Medicaid
LA1556912Medicaid
MS09705294Medicaid
G66379Medicare UPIN