Provider Demographics
NPI:1548759350
Name:ANDERSON, BRYCE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2936 THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1163
Mailing Address - Country:US
Mailing Address - Phone:586-256-0326
Mailing Address - Fax:
Practice Address - Street 1:1500 W BIG BEAVER RD STE 107
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3522
Practice Address - Country:US
Practice Address - Phone:248-689-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant