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NPI Code Detail

MEDICARE: DR. KEVIN PATRICK BRYAN M.D.

MEDICARE: DR. KEVIN PATRICK BRYAN M.D.
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
1208000000XPediatrics PhysicianMD417302PA
2208M00000XHospitalist PhysicianME121818FL
3208000000XPediatrics PhysicianME121818FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104811512
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN PATRICK BRYAN M.D.
Provider Business Mailing Address
First Line : 4200 SUN N LAKE BLVD
Second Line :
City : SEBRING
State : FL
Zip : 33872-1986
Country : US
Telephone Number : 407-975-0412
Fax Number : 407-975-0407
Provider Business Practice Location Address
First Line : 4200 SUN N LAKE BLVD
Second Line :
City : SEBRING
State : FL
Zip : 33872-1986
Country : US
Telephone Number : 407-975-0412
Fax Number : 407-975-0407
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2005
Last Update Date : 09/01/2020

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