Jerry L Bryan, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

21692 Issued in TX

Practice address

1200 Golden Key Cir
#140
El Paso, TX 79925-5820

Phone

(915) 598-9052

Fax

(915) 598-3674

NPI assigned

Feb 21, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dynamic Change Systems, Inc.

  • Clinical Psychologist
  • El Paso, TX
  • NPI 1720118771
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770628216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 GOLDEN KEY CIR",
            "address_2": "#140",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799255820",
            "telephone_number": "915-598-9052",
            "fax_number": "915-598-3674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 GOLDEN KEY CIR",
            "address_2": "#140",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799255820",
            "telephone_number": "915-598-9052",
            "fax_number": "915-598-3674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "JERRY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "21692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley Jo Bruns, DPT
• Sandra A Bruss Hand, L.P.C
• Brittany Nichole Bryan, RN
• Diane Hardwick Bryan, MPS, PH.D.
• Earl David Bryan, M.D.
• Arthur William Bryant, D.M.D.
• Michael Brywka III, DO
• Amy Elizabeth Brzuchalski, DNP, PMHNP-BC
• Darrell Eugene Buchanan, LCSW
• Patrick Buchanan, AUD

• Clinical Psychologist in El Paso, TX
• Providers in El Paso, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.