Provider Demographics
NPI:1548586118
Name:ALLEN, BRYAN JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JOSEPH
Last Name:ALLEN
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 1:200 3RD AVE W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8626
Mailing Address - Country:US
Mailing Address - Phone:941-792-0340
Mailing Address - Fax:941-794-2251
Practice Address - Street 1:2234 COLONIAL BLVD
Practice Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1412
Practice Address - Country:US
Practice Address - Phone:239-931-7342
Practice Address - Fax:239-931-7385
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME120341208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1192921OtherWELLCARE
FLP1033007OtherFREEDOM
FLP01796855OtherCLEAR HEALTH ALLIANCE
FL150JQOtherBCBS
FL9438549OtherCIGNA
FLP01520110OtherRAILROAD MEDICARE
FLP969301OtherOPTIMUM
FL015011500Medicaid
FL4840869OtherAETNA
FL015011500Medicaid