Provider Demographics
NPI:1609813401
Name:BRYANT, D'ORSAY D III (MD)
Entity Type:Individual
Prefix:
First Name:D'ORSAY
Middle Name:D
Last Name:BRYANT
Suffix:III
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 295
Mailing Address - Street 2:
Mailing Address - City:LOCKESBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71846-0295
Mailing Address - Country:US
Mailing Address - Phone:870-289-5865
Mailing Address - Fax:870-289-6993
Practice Address - Street 1:619 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4557
Practice Address - Country:US
Practice Address - Phone:870-863-3122
Practice Address - Fax:870-863-9377
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8197207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR13356000000OtherQUALCHOICE
AR121852001Medicaid
AR55700Medicare PIN
AR13356000000OtherQUALCHOICE
AR0523760001Medicare NSC
AR121852001Medicaid