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General NPI Number Information
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NPI Number | 1265547798
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Entity Type | Organization
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Legal Business Name | BRYAN MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 1400 BRYAN DR SUITE 211
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City | DURANT
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State | OK
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Zip | 74701-2156
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Country | US
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Telephone | 580-924-2424
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Fax | 580-924-2425
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Provider Business Mailing Address
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Address Line | 720 BRYAN DR SUITE A
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City | DURANT
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State | OK
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Zip | 74701-7032
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Country | US
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Telephone | 580-924-2424
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Fax | 580-924-2425
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SHYLA BUTT
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Credential | M.D.
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Telephone | 580-924-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 23789
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License Number State | OK
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