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NPI Code Detail

MEDICARE: KEITH G BRYSON MD

MEDICARE: KEITH G BRYSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician5987SD

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00414306OTHERSDRR MEDICARE

General Provider Information

NPI Number : 1003815804
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH G BRYSON MD
Provider Business Mailing Address
First Line : 353 FAIRMONT BLVD
Second Line : ATTEN MEDICAL STAFF SERVICES
City : RAPID CITY
State : SD
Zip : 57701-6000
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2805 5TH ST
Second Line : SUITE 100
City : RAPID CITY
State : SD
Zip : 57701-6003
Country : US
Telephone Number : 605-719-5700
Fax Number : 605-719-5701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 02/06/2013

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Directions to “ KEITH G BRYSON MD” Practice Location

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