Provider Demographics
NPI:1306388350
Name:BRYSON, LANCE (PA-C)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:BRYSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 J D ANDERSON DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1241
Mailing Address - Country:US
Mailing Address - Phone:304-599-3074
Mailing Address - Fax:304-598-1802
Practice Address - Street 1:1000 J D ANDERSON DR
Practice Address - Street 2:SUITE 401
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1241
Practice Address - Country:US
Practice Address - Phone:304-599-3074
Practice Address - Fax:304-598-1802
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV2787363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical