MEDICARE: DR. LUCAS M BRYANT 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
1	207YS0123X	Facial Plastic Surgery Physician	287468	NY
2	207YS0123X	Facial Plastic Surgery Physician	57875	TN

General Provider Information

NPI Number	:	1902166341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCAS M BRYANT MD

Provider Business Mailing Address
First Line	:	660 S MOUNT JULIET RD STE 120
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-3968
Country	:	US
Telephone Number	:	615-656-7859
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 S MOUNT JULIET RD STE 120
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-3968
Country	:	US
Telephone Number	:	615-656-7859
Fax Number	:

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

Provider Enumeration Date	:	05/19/2012
Last Update Date	:	10/23/2020

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