Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN8121 | FL |
NPI | 1073723003 |
---|---|
Provider Name | Dr. Walter Robert Bryant |
First Address | Altamonte Springs, FL 32714-1976 |
Second Address | Altamonte Springs, FL 32714-1976 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070427000 | (05) | FL |