Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 182 | TX |
Y | 222Z00000X | Podiatrist | 182 | TX |
NPI | 1063663193 |
---|---|
Provider Name | Kermit Edward Bryant |
First Address | San Antonio, TX 78229-4404 |
Second Address | San Antonio, TX 78229-4404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2008 |
Last Update Date | 07/10/2008 |