Provider Demographics
NPI:1366816175
Name:BRYSON, PHILIP LOWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:LOWELL
Last Name:BRYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PHILIP
Other - Middle Name:LOWELL
Other - Last Name:BRYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:21996 E QUINTERO RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-4582
Mailing Address - Country:US
Mailing Address - Phone:501-661-9295
Mailing Address - Fax:
Practice Address - Street 1:21996 E QUINTERO RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-4582
Practice Address - Country:US
Practice Address - Phone:801-661-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT154872-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine