MEDICARE: DR. JOSEPH M BRYAN M.D.

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	207L00000X	Anesthesiology Physician	ME0060770	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	14711Z	OTHER	FL	MEDICARE SECONDARY
9	050027899	OTHER	FL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14711	OTHER	FL	BSFL NASCO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	14711	OTHER	FL	BSFL
4	370203100	OTHER	FL	MEDIPASS
5	008001069	OTHER	FL	CIGNA PPO
6	14711	OTHER	FL	BSFL OUT OF STATE
8	790532	OTHER	FL	AETNA
10	14711Z	OTHER	FL	HOPE HOSPICE
11	0867335	OTHER	FL	CIGNA HMO
12	14711	OTHER	FL	BSFL HEALTH OPT
13	278295	OTHER	FL	AVMED HMO
14	370203100	OTHER	FL	CMS
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972506541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH M BRYAN M.D.

Provider Business Mailing Address
First Line	:	4048 EVANS AVE
Second Line	:	STE 303
City	:	FT MYERS
State	:	FL
Zip	:	33901-9390
Country	:	US
Telephone Number	:	239-332-5344
Fax Number	:	239-332-7246

Provider Business Practice Location Address
First Line	:	4048 EVANS AVE
Second Line	:	STE 303
City	:	FT MYERS
State	:	FL
Zip	:	33901-9390
Country	:	US
Telephone Number	:	239-332-5344
Fax Number	:	239-332-7246

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/31/2007

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