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General NPI Number Information
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NPI Number | 1841508652
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Entity Type | Organization
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Legal Business Name | JAMES W. BRYAN, MD INC
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 510 N PROSPECT AVE SUITE 305
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3028
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Country | US
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Telephone | 310-379-4906
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Fax |
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Provider Business Mailing Address
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Address Line | 510 N PROSPECT AVE SUITE 305
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3028
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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 | OWNER
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Name | JAMES W. BRYAN
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Credential | M.D.
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Telephone | 310-379-4906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | C33139
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License Number State | CA
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