Healthcare Provider Details

I. General information

NPI: 1851487417
Provider Name (Legal Business Name): THOMAS R. BRYANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 ALLISON BONNETT MEMORIAL DR
HUEYTOWN AL
35023-2317
US

IV. Provider business mailing address

PO BOX 11407 DEPT 2043
BIRMINGHAM AL
35246-2043
US

V. Phone/Fax

Practice location:
  • Phone: 205-491-3299
  • Fax: 205-744-8751
Mailing address:
  • Phone: 205-491-3299
  • Fax: 205-744-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number11392
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11392
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: