Provider Demographics
NPI:1417930769
Name:UNSELL, BRYAN JASON (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JASON
Last Name:UNSELL
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 1:4102 PINION DR
Mailing Address - Street 2:10TH MSGS/SGCR - RADIOLOGY
Mailing Address - City:US AIR FORCE ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-2502
Mailing Address - Country:US
Mailing Address - Phone:719-524-2273
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DRIVE
Practice Address - Street 2:10TH MSGS/SGCR - RADIOLOGY
Practice Address - City:US AIR FORCE ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-524-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00533732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology