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NPI Code Detail

MEDICARE: DR. JAMES WITT BRYAN IV MD

MEDICARE: DR. JAMES WITT BRYAN IV 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
1207QS0010XSports Medicine (Family Medicine) PhysicianC-7904AR
2207Q00000XFamily Medicine PhysicianC-7904AR
3207Q00000XFamily Medicine PhysicianC7904AR
4207QS0010XSports Medicine (Family Medicine) PhysicianC7904AR

Other Identifiers

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

General Provider Information

NPI Number : 1558326454
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES WITT BRYAN IV MD
Provider Business Mailing Address
First Line : 1090 ARNOLD DR
Second Line :
City : LITTLE ROCK AIR FORCE BASE
State : AR
Zip : 72099-4933
Country : US
Telephone Number : 501-987-7319
Fax Number : 501-987-1464
Provider Business Practice Location Address
First Line : 1090 ARNOLD DR
Second Line : 19 AMDS/SGPF
City : LITTLE ROCK AIR FORCE BASE
State : AR
Zip : 72099-4933
Country : US
Telephone Number : 501-987-7319
Fax Number : 501-987-1464
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 03/11/2024

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