Healthcare Provider Details

I. General information

NPI: 1114107828
Provider Name (Legal Business Name): BRYAN ARMANDO MEJIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E. HARRIS
SAN ANGELO TX
76903
US

IV. Provider business mailing address

3555 KNICKERBOCKER RD
SAN ANGELO TX
76904-7610
US

V. Phone/Fax

Practice location:
  • Phone: 325-481-2285
  • Fax:
Mailing address:
  • Phone: 325-949-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP9224
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: