Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | D0025268 | MD |
NPI | 1023117124 |
---|---|
Provider Name | Dr. Duane M Bryant |
First Address | Chula Vista, CA 91910-2625 |
Second Address | Chula Vista, CA 91910-2625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 30/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C155562 | CALIFORNIA MEDICAL LICENSE (01) | CA |