Healthcare Provider Details

I. General information

NPI: 1982654638
Provider Name (Legal Business Name): RODNEY K BRYANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: R KEVIN BRYANT MD

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/07/2023
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 S LAURA ST
WICHITA KS
67211
US

IV. Provider business mailing address

347 S LAURA ST
WICHITA KS
67211-1518
US

V. Phone/Fax

Practice location:
  • Phone: 316-686-7117
  • Fax: 316-686-2679
Mailing address:
  • Phone: 316-686-7117
  • Fax: 316-686-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number19204
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: