Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A80125 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 0101260383 | VA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 2010-01313 | NC |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | D0082026 | MD |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD044561 | DC |
NPI | 1174554398 |
---|---|
Provider Name | Dr. Brandon James Bryant |
First Address | Fairfax, VA 22031-4625 |
Second Address | Fairfax, VA 22031-4625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I51062 | (02) | CA |