Provider Demographics
NPI:1073622999
Name:CALCOTE, BRYAN S (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:S
Last Name:CALCOTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3730
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39603-7730
Mailing Address - Country:US
Mailing Address - Phone:601-835-0507
Mailing Address - Fax:601-835-2766
Practice Address - Street 1:527 SILVER CROSS DR
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2388
Practice Address - Country:US
Practice Address - Phone:601-835-0507
Practice Address - Fax:601-835-2766
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS14907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117192Medicaid
MS00117192Medicaid
G29734Medicare UPIN