Provider Demographics
NPI:1497847651
Name:BRYANT, JAMES LEE II (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEE
Last Name:BRYANT
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:527 MEDICAL PARK DRIVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330
Mailing Address - Country:US
Mailing Address - Phone:681-342-3571
Mailing Address - Fax:681-342-3575
Practice Address - Street 1:527 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 501
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:681-342-3571
Practice Address - Fax:681-342-3575
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-12-06
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Provider Licenses
StateLicense IDTaxonomies
WV08691207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0101431000Medicaid
9915191Medicare ID - Type Unspecified
WV0101431000Medicaid