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General NPI Number Information
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NPI Number | 1841240272
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Entity Type | Organization
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Legal Business Name | BRYAN NEUROLOGY SERVICES, P.A.
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 2100 BENT OAK ST
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City | COLLEGE STATION
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State | TX
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Zip | 77845-5585
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Country | US
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Telephone | 979-693-1931
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10102
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City | COLLEGE STATION
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State | TX
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Zip | 77842-0102
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Country | US
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Telephone | 979-693-1931
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDALL RAY LIGHT
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Credential | M.D.
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Telephone | 979-693-1931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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