Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 125059834 | IL |
Y | 207QS0010X | Family Doctor - Sports Medicine | 01078174A | IN |
NPI | 1326333618 |
---|---|
Provider Name | Dr. Joseen A Bryant |
First Address | Saint John, IN 46373-9487 |
Second Address | Saint John, IN 46373-9487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2011 |
Last Update Date | 06/07/2017 |