Unknown Individual – Psychiatry Physician, NPI 1285658344

Unknown Individual is a healthcare provider. based in Bryan, Texas. specializing in Psychiatry Physician. They hold a License No. C20638 (TX). The NPI Number for Unknown Individual is 1285658344

Main info

Organization
Inactive
61 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1285658344
Phone
(979) 822-6467
Address
804 TEXAS AVE.
Deactivation Date
22 May 2024

Doctor Profile

Medical School Name
UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
Secondary Phone
9363483695
Graduation Year
1965 (61 years ago)
PAC ID
7012051709
Group Practice PAC ID
8123008505
Professional Enrollment ID
I20100218000536
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 804, Texas Avenue South, Bryan, Brazos County, Texas, 77803, United States

    P.O. BOX 4588

    BRYAN, TX 778054588

    Phone: (979) 822-6467

    Fax: (979) 821-9448

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 77805)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8123008505View full group profile
NameSpecialtyState
Psychiatry, Pediatric MedicineTX
Nurse PractitionerTX
Physician AssistantTX
-TX

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1285658344.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Bryan, Texas in the data we show; additional addresses may exist on the full record.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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