Provider Demographics
NPI:1477924058
Name:BRYANT, CHARLES RAY
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RAY
Last Name:BRYANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 NW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-3710
Mailing Address - Country:US
Mailing Address - Phone:561-376-5482
Mailing Address - Fax:
Practice Address - Street 1:612 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-3710
Practice Address - Country:US
Practice Address - Phone:561-376-5482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide