Provider Demographics
NPI:1013041003
Name:O'BRYANT, WILLIAM BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRUCE
Last Name:O'BRYANT
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2300 MAIN ST
Mailing Address - Street 2:MAIL STOP CA124-0142
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6223
Mailing Address - Country:US
Mailing Address - Phone:949-632-4410
Mailing Address - Fax:
Practice Address - Street 1:5757 PLAZA DR
Practice Address - Street 2:MAIL STOP CA124-0142
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5000
Practice Address - Country:US
Practice Address - Phone:714-226-6884
Practice Address - Fax:949-588-1177
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG42434207R00000X
CO41348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48962Medicare UPIN