Provider Demographics
NPI:1306085535
Name:CORREA, BRYAN J (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:J
Last Name:CORREA
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 1:1723 TUAM ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-1252
Mailing Address - Country:US
Mailing Address - Phone:832-779-2778
Mailing Address - Fax:
Practice Address - Street 1:4850 W PANTHER CREEK DR
Practice Address - Street 2:#105
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3607
Practice Address - Country:US
Practice Address - Phone:832-779-2778
Practice Address - Fax:832-403-2201
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP50562086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery