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1326042037

NPI Code Detail

MEDICARE: BRYAN HOLLAN CLARDY M.D.

MEDICARE: BRYAN HOLLAN CLARDY 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
1	207Q00000X	Family Medicine Physician	E-2745	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	080184879	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7848374	OTHER		AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2220866	OTHER	AR	UNITED HEALTHCARE
5	2674666001	OTHER		CIGNA
6	5M245	OTHER	AR	BLUE CROSS/BLUE SHIELD
7	02090005200	OTHER		QUALCHOICE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326042037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN HOLLAN CLARDY M.D.

Provider Business Mailing Address
First Line	:	612 S 12TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4702
Country	:	US
Telephone Number	:	479-785-2431
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 S E ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4716
Country	:	US
Telephone Number	:	479-785-2431
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	03/07/2023

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Directions to “ BRYAN HOLLAN CLARDY M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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