Provider Demographics
NPI:1194832204
Name:BRYANT, ELIZABETH MAGUIRE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MAGUIRE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HUGHES ROAD, SUITE 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3040
Mailing Address - Country:US
Mailing Address - Phone:256-772-2037
Mailing Address - Fax:256-772-9523
Practice Address - Street 1:21 HUGHES ROAD, SUITE 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3040
Practice Address - Country:US
Practice Address - Phone:256-772-2037
Practice Address - Fax:256-772-9523
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235529208000000X
AL29126208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010186609Medicaid
VA010186609Medicaid