Provider Demographics
NPI:1427039726
Name:BRYAN, HERBIE SEYMOUR (MD)
Entity Type:Individual
Prefix:
First Name:HERBIE
Middle Name:SEYMOUR
Last Name:BRYAN
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 1:401 E CHEVES ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2615
Mailing Address - Country:US
Mailing Address - Phone:843-777-7863
Mailing Address - Fax:843-777-7873
Practice Address - Street 1:401 E CHEVES ST STE 202
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2615
Practice Address - Country:US
Practice Address - Phone:843-777-7863
Practice Address - Fax:843-777-7873
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101019207RP1001X
SC32149207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132NOMedicaid
NC132NOOtherBCBS
NC1427039726Medicaid
SC321495Medicaid
P00202187OtherRAIL ROAD MEDICARE
NCNCM280AMedicare PIN
NC2008123AMedicare PIN