Healthcare Provider Details

I. General information

NPI: 1992731178
Provider Name (Legal Business Name): BRYAN RADIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 OSLER BLVD
BRYAN TX
77802-2517
US

IV. Provider business mailing address

2700 OSLER BLVD
BRYAN TX
77802-2517
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-8291
  • Fax: 979-774-7871
Mailing address:
  • Phone: 979-776-8291
  • Fax: 979-774-7871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR02273
License Number StateTX

VIII. Authorized Official

Name: JASON PULNIK
Title or Position: PRESIDENT
Credential: MD
Phone: 979-776-8291