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General NPI Number Information
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NPI Number | 1770808149
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Entity Type | Individual
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Provider Name | BRENDA THARIAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 01/22/2018
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Provider Practice Location Address
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Address Line | 129 VISION PARK BLVD STE 301
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City | SHENANDOAH
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State | TX
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Zip | 77384-3024
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Country | US
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Telephone | 936-647-2184
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Fax | 936-647-2201
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Provider Business Mailing Address
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Address Line | 129 VISION PARK BLVD STE 301
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City | SHENANDOAH
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State | TX
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Zip | 77384-3024
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Country | US
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Telephone | 936-647-2184
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Fax | 936-647-2201
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | N6066
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License Number State | TX
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