Provider Demographics
NPI:1366501264
Name:BRYAN, ROY G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:G
Last Name:BRYAN
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 1:2221 W ELM STREET
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301
Mailing Address - Country:US
Mailing Address - Phone:307-324-2221
Mailing Address - Fax:307-324-8232
Practice Address - Street 1:2221 W ELM STREET
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301
Practice Address - Country:US
Practice Address - Phone:307-324-2221
Practice Address - Fax:307-324-8232
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY5363A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1092778400Medicaid
WY314111OtherBLX BLS
WY314111OtherBLX BLS
WYF84870Medicare UPIN
WYP00300803Medicare ID - Type UnspecifiedRR MEDICARE