Healthcare Provider Details

I. General information

NPI: 1669134631
Provider Name (Legal Business Name): NORTH TEXAS INSTITUTE OF NEUROLOGY AND HEADACHE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 DALLAS PKWY STE 100
PLANO TX
75024
US

IV. Provider business mailing address

5150 WARREN PKWY BLDG 8
FRISCO TX
75034-7462
US

V. Phone/Fax

Practice location:
  • Phone: 972-403-8184
  • Fax: 972-403-0685
Mailing address:
  • Phone: 972-765-5638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN MOISES BROWN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 972-453-1879