Provider Demographics
NPI:1528201001
Name:BRYAN, ANDREW LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEONARD
Last Name:BRYAN
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 1:228 BELL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-9525
Mailing Address - Country:US
Mailing Address - Phone:501-472-0855
Mailing Address - Fax:
Practice Address - Street 1:228 BELL BRANCH RD
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-9525
Practice Address - Country:US
Practice Address - Phone:501-472-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7256207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine