Healthcare Provider Details

I. General information

NPI: 1306283890
Provider Name (Legal Business Name): TIMOTHY BRYANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 S MULBERRY ST
PINE BLUFF AR
71603-7000
US

IV. Provider business mailing address

4010 S MULBERRY ST
PINE BLUFF AR
71603-7000
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-3280
  • Fax: 870-541-7622
Mailing address:
  • Phone: 870-541-3280
  • Fax: 870-541-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA142403
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE8855
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: