Basic Information
| Provider Information | |||||||||
| NPI: | 1659563047 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUEL | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | MENDOZA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., M.B.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9001 FOREST XING STE D | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773811132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135686095 | ||||||||
| FaxNumber: | 7139654091 | ||||||||
| Practice Location | |||||||||
| Address1: | 9717 JONES RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770654303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135686095 | ||||||||
| FaxNumber: | 7139654091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2007 | ||||||||
| LastUpdateDate: | 09/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | M7067 | TX | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 188356303 | 05 | TX | MEDICAID |