MEDICARE: RONALD BRYANT PA-C

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
1	363AM0700X	Medical Physician Assistant	PA640	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1295705960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD BRYANT PA-C

Provider Business Mailing Address
First Line	:	PO BOX 98978
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8978
Country	:	US
Telephone Number	:	702-216-3346
Fax Number	:	702-671-6883

Provider Business Practice Location Address
First Line	:	4275 BURNHAM AVE
Second Line	:	SUITE 220
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5488
Country	:	US
Telephone Number	:	702-369-0088
Fax Number	:	702-893-4913

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	06/07/2013

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Directions to “ RONALD BRYANT PA-C” Practice Location

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