MEDICARE: ROBERT NICK 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	2085N0700X	Neuroradiology Physician	MD068981	PA
2	2085N0700X	Neuroradiology Physician	MD068981L	PA
3	2085R0202X	Diagnostic Radiology Physician	MD068981L	PA
4	2085R0202X	Diagnostic Radiology Physician	D5925	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

General Provider Information

NPI Number	:	1578591616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT NICK BRYAN MD

Provider Business Mailing Address
First Line	:	1701 TRINITY STREET
Second Line	:	DELL MEDICAL SCHOOL
City	:	AUSTIN
State	:	TX
Zip	:	78712-1845
Country	:	US
Telephone Number	:	512-495-5063
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 TRINITY STREET
Second Line	:	DELL MEDICAL SCHOOL
City	:	AUSTIN
State	:	TX
Zip	:	78712-1845
Country	:	US
Telephone Number	:	512-495-5063
Fax Number	:

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	04/14/2017

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