MEDICARE: VIVIENNE ELAINE BRYAN MD

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	208D00000X	General Practice Physician	F8030	TX

General Provider Information

NPI Number	:	1558665117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIENNE ELAINE BRYAN MD

Provider Business Mailing Address
First Line	:	1234 WAGNER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3719
Country	:	US
Telephone Number	:	713-868-3301
Fax Number	:	713-868-4817

Provider Business Practice Location Address
First Line	:	1234 WAGNER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3719
Country	:	US
Telephone Number	:	713-868-3301
Fax Number	:	713-868-4817

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

Provider Enumeration Date	:	12/22/2010
Last Update Date	:	12/22/2010

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