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General NPI Number Information
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NPI Number | 1356924476
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Entity Type | Individual
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Provider Name | BRYCEN WITCHER MD
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Gender | Male
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 1308 PALUXY RD STE E
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City | GRANBURY
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State | TX
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Zip | 76048-5689
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Country | US
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Telephone | 817-573-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 3860 HAWTHORNE DR
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City | JACKSON
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State | MS
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Zip | 39206-5827
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31788
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | V6425
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License Number State | TX
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