Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 287468 | NY |
Y | 207YS0123X | Facial Plastic Surgeon | 57875 | TN |
NPI | 1902166341 |
---|---|
Provider Name | Dr. Lucas M Bryant |
First Address | Mt Juliet, TN 37122-3968 |
Second Address | Mt Juliet, TN 37122-3968 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2012 |
Last Update Date | 23/10/2020 |