Healthcare Provider Details

I. General information

NPI: 1205010428
Provider Name (Legal Business Name): BRYANT A TARR DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BOSTON POST RD SUITE 108
SUDBURY MA
01776-2463
US

IV. Provider business mailing address

111 BOSTON POST RD STE108
SUDBURY MA
01776-2463
US

V. Phone/Fax

Practice location:
  • Phone: 978-443-4878
  • Fax: 978-443-1470
Mailing address:
  • Phone: 978-443-4878
  • Fax: 978-443-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number001971
License Number StateMA

VIII. Authorized Official

Name: BRYANT A. TARR
Title or Position: OWNER
Credential: DPM
Phone: 978-443-4878