Provider Demographics
NPI:1346244977
Name:BRYAN, ELIZABETH (MD, PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 BEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2905
Mailing Address - Country:US
Mailing Address - Phone:910-592-8243
Mailing Address - Fax:
Practice Address - Street 1:227 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2905
Practice Address - Country:US
Practice Address - Phone:910-592-8243
Practice Address - Fax:910-592-1552
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2339388Medicare PIN