Provider Demographics
NPI:1215972591
Name:HYLAND, BRYAN TODD (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:TODD
Last Name:HYLAND
Suffix:
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 1:2210 THREE LAKES PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0642
Mailing Address - Country:US
Mailing Address - Phone:903-747-4050
Mailing Address - Fax:903-747-4075
Practice Address - Street 1:2210 THREE LAKES PKWY STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0642
Practice Address - Country:US
Practice Address - Phone:903-747-4050
Practice Address - Fax:903-747-4075
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH31994207Q00000X
TXK9711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8272N0Medicare PIN
H31994Medicare UPIN