Provider Demographics
NPI:1417173907
Name:SAULS, BRYAN AUSTON (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:AUSTON
Last Name:SAULS
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 1:625 AFRICA RD STE 240
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9808
Mailing Address - Country:US
Mailing Address - Phone:614-508-2672
Mailing Address - Fax:614-508-2668
Practice Address - Street 1:625 AFRICA RD STE 240
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9808
Practice Address - Country:US
Practice Address - Phone:614-508-2672
Practice Address - Fax:614-508-2668
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.091495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2841009Medicaid
OH4237302Medicare PIN