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General NPI Number Information
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NPI Number | 1801197280
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Entity Type | Organization
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Legal Business Name | BRYANT SURGICAL GROUP PC
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 13847 E 14TH ST SUITE #110
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City | SAN LEANDRO
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State | CA
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Zip | 94578-2632
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Country | US
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Telephone | 510-357-5566
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Fax |
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Provider Business Mailing Address
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Address Line | 13847 E 14TH ST SUITE #110
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City | SAN LEANDRO
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State | CA
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Zip | 94578-2632
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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 | PRESIDENT
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Name | DR. GARFIELD BRYANT
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Credential | M.D.
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Telephone | 510-357-5566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G85663
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License Number State | CA
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