MEDICARE: DR. MICHAEL BRYAN BEVINS M.D., PH.D.

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	207Q00000X	Family Medicine Physician	122184	NC
2	207Q00000X	Family Medicine Physician	M5633	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063631448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BRYAN BEVINS M.D., PH.D.

Provider Business Mailing Address
First Line	:	4107 SPICEWOOD SPRINGS RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8660
Country	:	US
Telephone Number	:	512-342-4731
Fax Number	:	512-795-9053

Provider Business Practice Location Address
First Line	:	4107 SPICEWOOD SPRINGS RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8660
Country	:	US
Telephone Number	:	512-342-4731
Fax Number	:	512-795-9053

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	03/09/2011

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