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NPI Code Detail

MEDICARE: JAMES M BRYAN MD

MEDICARE: JAMES M BRYAN MD
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
1207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianME71007FL
2207X00000XOrthopaedic Surgery PhysicianME71007FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497734107
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES M BRYAN MD
Provider Business Mailing Address
First Line : 1865 LPGA BLVD
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32117-7108
Country : US
Telephone Number : 386-255-4596
Fax Number : 386-258-3561
Provider Business Practice Location Address
First Line : 1865 LPGA BLVD
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32117-7108
Country : US
Telephone Number : 386-255-4596
Fax Number : 386-258-3561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 11/20/2024

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