Provider Demographics
NPI:1114961786
Name:BRYANT, PATRICIA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4640 JEFFERSON LN NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2116
Mailing Address - Country:US
Mailing Address - Phone:505-883-1259
Mailing Address - Fax:505-883-3020
Practice Address - Street 1:4640 JEFFERSON LN NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2116
Practice Address - Country:US
Practice Address - Phone:505-883-1259
Practice Address - Fax:505-883-3020
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM86-185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME09276Medicare UPIN