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NPI Code Detail

MEDICARE: BRYANT FAMILY MEDICAL CLINIC, P.A.

MEDICARE: BRYANT FAMILY MEDICAL CLINIC, P.A.
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
1261QM2500XMedical Specialty Clinic/CenterMC2196AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MC2196OTHERARARKANSAS STATE MEDICAL BO

General Provider Information

NPI Number : 1073640769
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRYANT FAMILY MEDICAL CLINIC, P.A.
Provider Business Mailing Address
First Line : 408 OFFICE PARK DR STE 3
Second Line :
City : BRYANT
State : AR
Zip : 72022-7536
Country : US
Telephone Number : 501-847-2835
Fax Number : 501-847-6809
Provider Business Practice Location Address
First Line : 408 OFFICE PARK DR STE 3
Second Line :
City : BRYANT
State : AR
Zip : 72022-7536
Country : US
Telephone Number : 501-847-2835
Fax Number : 501-847-6809
Authorized Official
Title or Position : BUSINESS MANAGER
Name : GAELLE BRYANT
Credential :
Telephone Number : 501-804-9712
Provider Enumeration Date : 02/28/2007
Last Update Date : 07/24/2019

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