Healthcare Provider Details

I. General information

NPI: 1790195758
Provider Name (Legal Business Name): JESSICA BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIGHAM AND WOMEN'S HOSPITAL 75 FRANCIS ST
BOSTON MA
02115
US

IV. Provider business mailing address

500 PARNASSUS AVE MU 320 WEST
SAN FRANCISCO CA
94143-2203
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5384
  • Fax:
Mailing address:
  • Phone: 415-476-6548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number278247
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: