MEDICARE: BRYAN KEITH DEMARIE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	K9256	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225085822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN KEITH DEMARIE M.D.

Provider Business Mailing Address
First Line	:	6750 N MACARTHUR BLVD
Second Line	:	SUITE 350
City	:	IRVING
State	:	TX
Zip	:	75039-2875
Country	:	US
Telephone Number	:	972-556-1616
Fax Number	:	972-556-1740

Provider Business Practice Location Address
First Line	:	6750 N MACARTHUR BLVD
Second Line	:	SUITE 350
City	:	IRVING
State	:	TX
Zip	:	75039-2875
Country	:	US
Telephone Number	:	972-556-1616
Fax Number	:	972-556-1740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	10/23/2019

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Directions to “ BRYAN KEITH DEMARIE M.D.” Practice Location

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