MEDICARE: BRYAN STEPHENS DO

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	T7745	TX

General Provider Information

NPI Number	:	1598320855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN STEPHENS DO

Provider Business Mailing Address
First Line	:	921 S SAVAGE CREEK LN
Second Line	:
City	:	BROCK
State	:	TX
Zip	:	76087-4061
Country	:	US
Telephone Number	:	817-727-2735
Fax Number	:

Provider Business Practice Location Address
First Line	:	6302 LAKE WORTH BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3607
Country	:	US
Telephone Number	:	817-237-8273
Fax Number	:	817-237-0374

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

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	02/15/2024

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Directions to “ BRYAN STEPHENS DO” Practice Location

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