Provider Demographics
NPI:1396833539
Name:BRYSON, LARRY D (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:BRYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:
Other - Last Name:BRYSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:242 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-1550
Mailing Address - Country:US
Mailing Address - Phone:415-990-0083
Mailing Address - Fax:707-963-1831
Practice Address - Street 1:242 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-1550
Practice Address - Country:US
Practice Address - Phone:415-990-0083
Practice Address - Fax:707-963-1831
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396833539OtherNATIONAL PROVIDER NUMBER
CA00G34568OtherMEDICARE PROVIDER NUMBER
CAA89583Medicare UPIN