Provider Demographics
NPI:1063484335
Name:BRYARS, CHARLES HENRY III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:HENRY
Last Name:BRYARS
Suffix:III
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 1:2270 HILLCREST ROAD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695
Mailing Address - Country:US
Mailing Address - Phone:251-666-2213
Mailing Address - Fax:251-660-8037
Practice Address - Street 1:2270 HILLCREST ROAD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695
Practice Address - Country:US
Practice Address - Phone:251-666-2213
Practice Address - Fax:251-660-8037
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C72036Medicare UPIN