Healthcare Provider Details

I. General information

NPI: 1124000435
Provider Name (Legal Business Name): DAVID BRYANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 N EMPORIA ST
WICHITA KS
67214-3709
US

IV. Provider business mailing address

PO BOX 1897
WICHITA KS
67201-1897
US

V. Phone/Fax

Practice location:
  • Phone: 316-268-5927
  • Fax: 316-291-7940
Mailing address:
  • Phone: 316-268-8131
  • Fax: 316-291-4788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number04-33095
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: