Healthcare Provider Details

I. General information

NPI: 1659548899
Provider Name (Legal Business Name): ALLYSON K BRYANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 BLUE RIDGE RD STE 330
RALEIGH NC
27607-6475
US

IV. Provider business mailing address

2605 BLUE RIDGE RD STE 330
RALEIGH NC
27607-6475
US

V. Phone/Fax

Practice location:
  • Phone: 336-575-4351
  • Fax: 949-655-8783
Mailing address:
  • Phone: 336-575-4351
  • Fax: 949-655-8783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2011-00467
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2011-00467
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2011-00467
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: