Provider Demographics
NPI:1417214701
Name:BRYAN, ALLEN WAYNE JR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:WAYNE
Last Name:BRYAN
Suffix:JR
Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-4344
Mailing Address - Fax:617-667-7120
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-4344
Practice Address - Fax:617-667-7120
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2015-11-03
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Provider Licenses
StateLicense IDTaxonomies
390200000X
AL34658207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program