Healthcare Provider Details

I. General information

NPI: 1235892753
Provider Name (Legal Business Name): BRADY HOYT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N WASHINGTON AVE STE 4000
DALLAS TX
75246-1776
US

IV. Provider business mailing address

2772 GASON AVE APT. 14113
DALLAS TX
75226
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-7457
  • Fax:
Mailing address:
  • Phone: 585-260-1738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number682
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: