Provider Demographics
NPI:1992731178
Name:BRYAN RADIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:BRYAN RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PULNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-776-8291
Mailing Address - Street 1:2700 OSLER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2517
Mailing Address - Country:US
Mailing Address - Phone:979-776-8291
Mailing Address - Fax:979-774-7871
Practice Address - Street 1:2700 OSLER BLVD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2517
Practice Address - Country:US
Practice Address - Phone:979-776-8291
Practice Address - Fax:979-774-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR022732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093810201Medicaid
TXF82166Medicare UPIN
TX8L24801Medicare PIN
TX00BC21Medicare PIN
TX8K5465Medicare PIN
TXI59594Medicare UPIN
TXH10037Medicare UPIN
TXG97547Medicare UPIN
TX8L12947Medicare PIN
TXTXB151945Medicare PIN
TXC14131Medicare UPIN
TXC21437Medicare UPIN
TXTXB124065Medicare PIN
TXI37928Medicare UPIN
TXH83736Medicare UPIN
TXG72816Medicare UPIN
TXB22482Medicare UPIN
TXB27564Medicare UPIN
TX8L0392Medicare PIN