Provider Demographics
NPI:1356652036
Name:CAGLE, BRYSTOL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYSTOL
Middle Name:
Last Name:CAGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRYSTOL
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:125 DOUGHTY ST
Mailing Address - Street 2:STE 420
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5741
Mailing Address - Country:US
Mailing Address - Phone:843-723-3441
Mailing Address - Fax:843-805-4040
Practice Address - Street 1:125 DOUGHTY ST STE 420
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5741
Practice Address - Country:US
Practice Address - Phone:843-723-3441
Practice Address - Fax:843-805-4040
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32779207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology