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General NPI Number Information
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NPI Number | 1306085535
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Entity Type | Individual
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Provider Name | BRYAN J CORREA M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 4850 W PANTHER CREEK DR #105
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City | THE WOODLANDS
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State | TX
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Zip | 77381-3607
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Country | US
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Telephone | 832-779-2778
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Fax | 832-403-2201
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Provider Business Mailing Address
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Address Line | 1723 TUAM ST
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City | HOUSTON
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State | TX
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Zip | 77004-1252
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Country | US
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Telephone | 832-779-2778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | P5056
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | P5056
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License Number State | TX
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