Provider Demographics
NPI:1609090141
Name:BRYAN, ROBERT ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ERIC
Last Name:BRYAN
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:PO BOX 21709
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-0809
Mailing Address - Country:US
Mailing Address - Phone:912-634-7714
Mailing Address - Fax:912-634-7734
Practice Address - Street 1:143 FOLLINS LN
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-4263
Practice Address - Country:US
Practice Address - Phone:912-634-7714
Practice Address - Fax:912-634-7734
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022122207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA79BBBCMMedicare PIN
E19904Medicare UPIN