Healthcare Provider Details

I. General information

NPI: 1467416552
Provider Name (Legal Business Name): JOHN HUGH BRYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

IV. Provider business mailing address

PO BOX 41208
FAYETTEVILLE NC
28309-1208
US

V. Phone/Fax

Practice location:
  • Phone: 910-609-6690
  • Fax: 910-609-6313
Mailing address:
  • Phone: 910-609-6691
  • Fax: 910-609-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number16328
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: