Healthcare Provider Details

I. General information

NPI: 1346244977
Provider Name (Legal Business Name): ELIZABETH BRYAN M.D., P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 BEAMAN ST
CLINTON NC
28328-2905
US

IV. Provider business mailing address

227 BEAMAN ST
CLINTON NC
28328-2905
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-8243
  • Fax: 910-592-1552
Mailing address:
  • Phone: 910-592-8243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200400646
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: