Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 022122 | GA |
NPI | 1609090141 |
---|---|
Provider Name | Robert Eric Bryan |
First Address | Saint Simons Island, GA 31522-0809 |
Second Address | Saint Simons Island, GA 31522-4263 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 20/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E19904 | (02) |