MEDICARE: DR. BRYAN ALLAN ONG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	P9105	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8EN071	OTHER	TX	BCBS TX

General Provider Information

NPI Number	:	1013117530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN ALLAN ONG MD

Provider Business Mailing Address
First Line	:	7610 N STEMMONS FWY STE 600
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-4228
Country	:	US
Telephone Number	:	214-689-5960
Fax Number	:	469-713-8084

Provider Business Practice Location Address
First Line	:	7620 NE LOOP 820
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8302
Country	:	US
Telephone Number	:	817-284-2693
Fax Number	:	817-284-1819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	09/25/2020

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