MEDICARE: BRIAN DAVID WASSON M.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	M3421	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	:	1780603266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DAVID WASSON M.D.

Provider Business Mailing Address
First Line	:	4925 S HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1407
Country	:	US
Telephone Number	:	817-263-9700
Fax Number	:	817-795-8100

Provider Business Practice Location Address
First Line	:	4925 S HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1407
Country	:	US
Telephone Number	:	817-263-9700
Fax Number	:	817-795-8100

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	09/19/2025

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