Provider Demographics
NPI:1083672489
Name:BRYANT, FRANK T (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:T
Last Name:BRYANT
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 1:115 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5110
Mailing Address - Country:US
Mailing Address - Phone:575-622-7600
Mailing Address - Fax:575-622-3856
Practice Address - Street 1:115 E 19TH ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5110
Practice Address - Country:US
Practice Address - Phone:575-622-7600
Practice Address - Fax:575-622-3856
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85147207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36442Medicaid
NM85147OtherNM LICENSE
D43059Medicare UPIN