Healthcare Provider Details

I. General information

NPI: 1467716522
Provider Name (Legal Business Name): ERIC THOMAS BRYANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 BECKLEY RD
BATTLE CREEK MI
49015-7941
US

IV. Provider business mailing address

4520 BECKLEY RD
BATTLE CREEK MI
49015-7941
US

V. Phone/Fax

Practice location:
  • Phone: 269-969-8723
  • Fax: 269-969-8724
Mailing address:
  • Phone: 269-969-8723
  • Fax: 269-969-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301101661
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: