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NPI Code Detail

MEDICARE: MR. VERNON BRYAN

MEDICARE: MR. VERNON BRYAN
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1790227999
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. VERNON BRYAN
Provider Business Mailing Address
First Line : 19436 PACKARD ST
Second Line :
City : DETROIT
State : MI
Zip : 48234-3195
Country : US
Telephone Number : 313-231-6049
Fax Number :
Provider Business Practice Location Address
First Line : 19436 PACKARD ST
Second Line :
City : DETROIT
State : MI
Zip : 48234-3195
Country : US
Telephone Number : 313-231-6049
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2016
Last Update Date : 11/06/2016

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Directions to “ MR. VERNON BRYAN ” Practice Location

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