Provider Demographics
NPI:1033133954
Name:BRYAN, BARRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRETT
Middle Name:
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WHIPPLE AVE #130
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2844
Mailing Address - Country:US
Mailing Address - Phone:650-298-8774
Mailing Address - Fax:650-298-8667
Practice Address - Street 1:2900 WHIPPLE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2843
Practice Address - Country:US
Practice Address - Phone:650-298-8774
Practice Address - Fax:650-298-8667
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG021852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A41403Medicare UPIN
ZZZ16205ZMedicare ID - Type Unspecified