Provider Demographics
NPI:1558317891
Name:BRYANT, COLIN C (MD)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:C
Last Name:BRYANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:740 E LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8601
Mailing Address - Country:US
Mailing Address - Phone:606-877-3931
Mailing Address - Fax:606-877-3978
Practice Address - Street 1:310 E 9TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1204
Practice Address - Country:US
Practice Address - Phone:606-878-6520
Practice Address - Fax:606-877-3978
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33513207L00000X
OH35.069868207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61-1427889OtherBLUEGRASS FAMILY HEALTH
KY61-1427889OtherUHC
KY64039233Medicaid
KYP00309186OtherRRMCR
KYC20361OtherCUMBERLAND HEALTHCARE INC
KY61-1427889OtherCHA
KY030670000OtherBLACK LUNG
KY000000476589OtherANTHEM
KY50010606OtherPASSPORT HEALTH PLAN
KY61-1427889OtherTRICARE
KY61-1427889OtherHUMANA
KYC20361OtherCUMBERLAND HEALTHCARE INC
KY50010606OtherPASSPORT HEALTH PLAN