Healthcare Provider Details

I. General information

NPI: 1174594675
Provider Name (Legal Business Name): BRYAN D PROPES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE 300
JACKSON MS
39202-2027
US

IV. Provider business mailing address

1200 N STATE ST STE 300
JACKSON MS
39202-2027
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5000
  • Fax:
Mailing address:
  • Phone: 601-981-4091
  • Fax: 601-981-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101233570
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD67835
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: