MEDICARE: JEFFRY MICHAEL BRYEN PA

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	363A00000X	Physician Assistant	699	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265491237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFRY MICHAEL BRYEN PA

Provider Business Mailing Address
First Line	:	PO BOX 113
Second Line	:
City	:	WANETTE
State	:	OK
Zip	:	74878-0113
Country	:	US
Telephone Number	:	405-694-6950
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 S DOUGLAS BLVD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6221
Country	:	US
Telephone Number	:	405-302-8999
Fax Number	:	405-733-9360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	04/05/2024

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