Provider Demographics
NPI:1033642103
Name:BRYANT-HUPPERT, JOE EUGENE LLOYD
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:EUGENE LLOYD
Last Name:BRYANT-HUPPERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 N 5TH ST APT 205
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-5801
Mailing Address - Country:US
Mailing Address - Phone:715-222-2222
Mailing Address - Fax:
Practice Address - Street 1:525 EAST 68TH STREET, BOX 124
Practice Address - Street 2:WEILL CORNELL MEDICINE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-746-2941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program