Provider Demographics
NPI:1497750418
Name:BRYLES, JEFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:BRYLES
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:PO BOX 1272
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-1272
Mailing Address - Country:US
Mailing Address - Phone:870-535-7457
Mailing Address - Fax:870-535-2522
Practice Address - Street 1:1801 W 40TH AVE
Practice Address - Street 2:STE 2B
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6957
Practice Address - Country:US
Practice Address - Phone:870-535-7457
Practice Address - Fax:870-535-2522
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7667207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127266001Medicaid
430054884OtherRRMCR/PGBA
AR53467OtherBCBS
E33405Medicare UPIN
AR53467Medicare PIN