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General NPI Number Information
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NPI Number | 1730499948
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Entity Type | Organization
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Legal Business Name | CYNTHIA BLACKWELL BRYAN MD PA
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 05/30/2015
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Provider Practice Location Address
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Address Line | 1001 W. COLLEGE BLVD SUITE G
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City | NICEVILLE
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State | FL
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Zip | 32578
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Country | US
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Telephone | 850-897-1700
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Fax | 850-897-1792
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Provider Business Mailing Address
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Address Line | 1001 W. COLLEGE BLVD SUITE G
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City | NICEVILLE
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State | FL
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Zip | 32578
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Country | US
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Telephone | 850-897-1700
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Fax | 850-897-1792
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MS. CYNTHIA BLACKWELL BRYAN
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Credential | M.D.
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Telephone | 850-897-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME80397
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License Number State | FL
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