Healthcare Provider Details

I. General information

NPI: 1720070568
Provider Name (Legal Business Name): WESLEY W BRYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MAIN ST STE 21
DOTHAN AL
36305-1058
US

IV. Provider business mailing address

4300 W MAIN ST STE 21
DOTHAN AL
36305-1058
US

V. Phone/Fax

Practice location:
  • Phone: 334-699-7900
  • Fax: 334-699-7901
Mailing address:
  • Phone: 334-699-7900
  • Fax: 334-699-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number55070
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: