Provider Demographics
NPI:1588759443
Name:BRYARLY, RICHARD COLWIN JR (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:COLWIN
Last Name:BRYARLY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 N MO PAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4006
Mailing Address - Fax:512-901-3906
Practice Address - Street 1:12221 N MO PAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4006
Practice Address - Fax:512-901-3906
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4228207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00729025OtherRRMCR
TX110346702Medicaid
TX110346704Medicaid
TXB89310Medicare UPIN
TX8L8930Medicare PIN
TX86M955Medicare PIN
TXP00729025OtherRRMCR