Healthcare Provider Details

I. General information

NPI: 1700897477
Provider Name (Legal Business Name): SEAN O. BRYANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1746 COLE BLVD STE 150
LAKEWOOD CO
80401-3208
US

IV. Provider business mailing address

1746 COLE BLVD STE 150
LAKEWOOD CO
80401-3208
US

V. Phone/Fax

Practice location:
  • Phone: 303-914-8800
  • Fax: 303-716-3777
Mailing address:
  • Phone: 303-914-8800
  • Fax: 303-716-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number38916
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0038916
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: