Provider Demographics
NPI:1992047872
Name:TEW, BRIAN HARALSON (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:HARALSON
Last Name:TEW
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 1:4134 VILLANOVA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-3527
Mailing Address - Country:US
Mailing Address - Phone:713-594-4747
Mailing Address - Fax:713-481-8323
Practice Address - Street 1:4134 VILLANOVA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-3527
Practice Address - Country:US
Practice Address - Phone:713-594-4747
Practice Address - Fax:713-481-8323
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2060207Q00000X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine