Provider Demographics
NPI:1144217324
Name:BRYER, MARK P (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:BRYER
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 1:1705 E BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7167
Mailing Address - Country:US
Mailing Address - Phone:573-874-7800
Mailing Address - Fax:573-607-3878
Practice Address - Street 1:1705 E BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7166
Practice Address - Country:US
Practice Address - Phone:573-874-7800
Practice Address - Fax:573-443-3627
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1029932085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5132415OtherAETNA
E71404OtherMERCY HEALTH PLANS
2400004OtherUNITED HEALTHCARE
19991OtherBCBS OF MO
23324152OtherBCBS OF KC
65201A017OtherTRICARE
MO206676603Medicaid
11440OtherGHP
257403OtherHEALTHLINK
23324152OtherBCBS OF KC
E71404Medicare UPIN
65201A017OtherTRICARE
MO920002745Medicare PIN
MO127530005Medicare PIN
MO920001423Medicare PIN
5132415OtherAETNA
257403OtherHEALTHLINK
MO001012700Medicare PIN