MEDICARE: BRYANT MEDICAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	12777	NV

General Provider Information

NPI Number	:	1023268026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYANT MEDICAL PLLC

Provider Business Mailing Address
First Line	:	4241 MAPLE ST STE 200D
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3826
Country	:	US
Telephone Number	:	866-379-2235
Fax Number	:	702-946-6670

Provider Business Practice Location Address
First Line	:	2721 E RUSSELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2490
Country	:	US
Telephone Number	:	866-379-2235
Fax Number	:	702-946-6670

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EVERETT V BRYANT
Credential	:	M.D.
Telephone Number	:	313-584-1940

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	09/25/2008

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