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General NPI Number Information
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NPI Number | 1578614749
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Entity Type | Individual
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Provider Name | LARRY KENNETH O'BRYANT MD
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Gender | Male
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 407 14TH AVE SE
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City | PUYALLUP
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State | WA
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Zip | 98372-3770
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Country | US
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Telephone | 253-697-5647
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Fax |
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Provider Business Mailing Address
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Address Line | 2910 16TH ST SE
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City | PUYALLUP
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State | WA
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Zip | 98374-1379
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Country | US
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Telephone |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD38704
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License Number State | WA
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