Healthcare Provider Details

I. General information

NPI: 1477051365
Provider Name (Legal Business Name): DAVID AUGUSTUS BRYANT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 SE 8TH TER
CAPE CORAL FL
33990-3212
US

IV. Provider business mailing address

12730 NEW BRITTANY BLVD STE 602
FORT MYERS FL
33907-4690
US

V. Phone/Fax

Practice location:
  • Phone: 239-574-1988
  • Fax:
Mailing address:
  • Phone: 239-275-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS16327
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberOS16327
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: