Provider Demographics
NPI:1538327267
Name:SAKAMOTO, BRYAN MAKOTO (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:MAKOTO
Last Name:SAKAMOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1481 WEST 10TH STREET
Mailing Address - Street 2:RICHARD L. ROUDEBUSH VA MEDICAL CENTER
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-988-4699
Mailing Address - Fax:317-988-3163
Practice Address - Street 1:1481 WEST 10TH STREET
Practice Address - Street 2:RICHARD L. ROUDEBUSH VA MEDICAL CENTER
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-988-4699
Practice Address - Fax:317-988-3163
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01065544A207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine