Provider Demographics
NPI:1497930119
Name:BRYANT, TANYA ELAINE I (MD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:ELAINE
Last Name:BRYANT
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-369-1563
Practice Address - Street 1:2505 E DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1401
Practice Address - Country:US
Practice Address - Phone:559-457-5500
Practice Address - Fax:559-457-5599
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15941207K00000X, 208000000X
CAC53527208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF58759Medicare UPIN
SCF587594784Medicare PIN
SCF587597977Medicare PIN
SC159410Medicaid