Healthcare Provider Details

I. General information

NPI: 1487679163
Provider Name (Legal Business Name): R SAMUEL BRYANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 A ST STE 100
LINCOLN NE
68510-4205
US

IV. Provider business mailing address

7001 A ST STE 100
LINCOLN NE
68510-4205
US

V. Phone/Fax

Practice location:
  • Phone: 402-484-7001
  • Fax: 402-484-7006
Mailing address:
  • Phone: 402-484-7001
  • Fax: 402-484-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number17600
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: