Johnny Bryant, REVERAND
Individual provider Active NPI Driver · Houston, TX
NPI 1104157551 · NPPES record last updated Jan 26, 2010
Key facts
- NPI
- 1104157551
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 172A00000X (TX)
- Practice address
- 9797 Meadowglen LN
Houston, TX 77042-4626 - Phone
- (832) 417-1703
- NPI assigned
- Jan 26, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 172A00000X | TX | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 172A00000X | TX | Yes |
Addresses
Primary practice location
9797 Meadowglen LN
Houston, TX 77042-4626
Mailing address
PO Box 740803
Houston, TX 77274-0803
Phone (832) 417-1703
Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.