MEDICARE: MR. ROBERT RAY BRYANT PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1487756839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT RAY BRYANT PA

Provider Business Mailing Address
First Line	:	303 KYLE CT
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-8034
Country	:	US
Telephone Number	:	843-993-6790
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 W HILL BLVD
Second Line	:
City	:	CHARLESTON AFB
State	:	SC
Zip	:	29404-4704
Country	:	US
Telephone Number	:	843-963-6790
Fax Number	:

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/08/2007

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