Healthcare Provider Details

I. General information

NPI: 1619397809
Provider Name (Legal Business Name): BRYAUNA LEWIS DUNCOMBE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2014
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N 7TH ST
WEST MEMPHIS AR
72301-2001
US

IV. Provider business mailing address

900 N 7TH ST
WEST MEMPHIS AR
72301-2001
US

V. Phone/Fax

Practice location:
  • Phone: 870-735-3842
  • Fax:
Mailing address:
  • Phone: 870-735-3842
  • Fax: 870-394-9476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.34523
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE17527
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: