Provider Demographics
NPI:1811975063
Name:ULRICH, BRIAN KENT (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KENT
Last Name:ULRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:B.
Other - Middle Name:KENT
Other - Last Name:ULRICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:5400 KELL BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1610
Practice Address - Country:US
Practice Address - Phone:940-691-8271
Practice Address - Fax:940-692-2042
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6417207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX39033801Medicaid
TX39033802Medicaid
OK100194680AMedicaid
TX39033803Medicaid
OK100194680AMedicaid
TX39033803Medicaid
TX816799Medicare PIN
TXP00320024Medicare PIN