Healthcare Provider Details

I. General information

NPI: 1053367391
Provider Name (Legal Business Name): BRIAN RANDALL RILEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 RESEARCH BLVD STE 400
AUSTIN TX
78759-7364
US

IV. Provider business mailing address

565 CROSSWATER LN
DRIPPING SPRINGS TX
78620-2087
US

V. Phone/Fax

Practice location:
  • Phone: 305-923-1144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number02002196A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberOS15178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: