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General NPI Number Information
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NPI Number | 1427363449
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Entity Type | Individual
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Provider Name | JUSTIN R BRYANT DO, MBA
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Gender | Male
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 11141 PARKVIEW PLAZA DR STE 300
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City | FORT WAYNE
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State | IN
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Zip | 46845-1715
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Country | US
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Telephone | 260-425-6960
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 947407
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City | ATLANTA
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State | GA
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Zip | 30394-7407
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Country | US
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Telephone | 941-917-2600
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Fax | 941-917-7884
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 71983
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | DO034726
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 02004908A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | OS21663
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License Number State | FL
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