Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 042056 | NY |
NPI | 1841248226 |
---|---|
Provider Name | Dr. Amy Ruth Bryan |
First Address | Buffalo, NY 14209-2003 |
Second Address | Buffalo, NY 14209-2003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01140087 | (05) | NY |