Healthcare Provider Details

I. General information

NPI: 1497750418
Provider Name (Legal Business Name): JEFFREY S BRYLES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 40TH AVE STE 2B
PINE BLUFF AR
71603-6957
US

IV. Provider business mailing address

PO BOX 1272
PINE BLUFF AR
71613-1272
US

V. Phone/Fax

Practice location:
  • Phone: 870-535-7457
  • Fax: 870-535-2522
Mailing address:
  • Phone: 870-535-7457
  • Fax: 870-535-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC7667
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: