Healthcare Provider Details

I. General information

NPI: 1265926422
Provider Name (Legal Business Name): BRYAN NICHOLAS ANKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 E ARROW HWY
POMONA CA
91767-2535
US

IV. Provider business mailing address

845 E ARROW HWY
POMONA CA
91767-2535
US

V. Phone/Fax

Practice location:
  • Phone: 909-526-1756
  • Fax:
Mailing address:
  • Phone: 909-526-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301115960
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA174880
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA174880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: