Healthcare Provider Details

I. General information

NPI: 1942474515
Provider Name (Legal Business Name): BARBARA JEAN BRYANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 N 18TH ST
MILWAUKEE WI
53233-2121
US

IV. Provider business mailing address

638 N 18TH ST
MILWAUKEE WI
53233-2121
US

V. Phone/Fax

Practice location:
  • Phone: 414-937-6281
  • Fax:
Mailing address:
  • Phone: 414-937-6281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberM0363
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number60704-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: