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General NPI Number Information
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NPI Number | 1215942248
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Entity Type | Individual
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Provider Name | BRYAN S. LANTRIP M. D.
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Gender | Male
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 969 LAKELAND DR
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City | JACKSON
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State | MS
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Zip | 39216-4606
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Country | US
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Telephone | 877-406-2916
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Fax | 601-682-7909
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Provider Business Mailing Address
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Address Line | PO BOX 55769
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City | JACKSON
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State | MS
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Zip | 39296-5769
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Country | US
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Telephone | 601-200-6162
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number | 13254
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 13254
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License Number State | MS
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