Provider Demographics
NPI:1558708701
Name:BRYAN, ISAAC GENE (DO)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:GENE
Last Name:BRYAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1330 CEDAR LN STE 700
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3276
Mailing Address - Country:US
Mailing Address - Phone:931-455-7400
Mailing Address - Fax:931-455-6344
Practice Address - Street 1:1330 CEDAR LN STE 700
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3276
Practice Address - Country:US
Practice Address - Phone:931-455-7400
Practice Address - Fax:931-455-6344
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11133432-1204207N00000X
TN3897207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery