MEDICARE: ELIZABETH BRYAN M.D., 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
1	207Q00000X	Family Medicine Physician	200400646	NC

General Provider Information

NPI Number	:	1346244977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BRYAN M.D., P.A.

Provider Business Mailing Address
First Line	:	227 BEAMAN ST
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328-2905
Country	:	US
Telephone Number	:	910-592-8243
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 BEAMAN ST
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328-2905
Country	:	US
Telephone Number	:	910-592-8243
Fax Number	:	910-592-1552

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	06/30/2010

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