Provider Demographics
NPI:1467716522
Name:BRYANT, ERIC THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:THOMAS
Last Name:BRYANT
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 1:4520 BECKLEY RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7941
Mailing Address - Country:US
Mailing Address - Phone:269-969-8723
Mailing Address - Fax:269-969-8724
Practice Address - Street 1:4520 BECKLEY RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7941
Practice Address - Country:US
Practice Address - Phone:269-969-8723
Practice Address - Fax:269-969-8724
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101661208000000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program