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General NPI Number Information
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NPI Number | 1679764286
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Entity Type | Organization
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Legal Business Name | BRYAN H. MINTON, MD, PA
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 1422 W MAIN ST SUITE 100A
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City | LEWISVILLE
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State | TX
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Zip | 75067-3387
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Country | US
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Telephone | 972-221-3924
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 844128
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City | DALLAS
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State | TX
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Zip | 75284
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Country | US
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Telephone | 972-860-8648
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Fax |
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Authorized Official
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Title or Position | OFFICE MGR.
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Name | SUZAN BURTON
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Credential |
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Telephone | 972-221-3924
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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 | L2475
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License Number State | TX
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