Provider Demographics
NPI:1609815190
Name:BRYAN, JENNIFER ANN ADAMS (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN ADAMS
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:ADAMS BRYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:13695 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-5403
Practice Address - Country:US
Practice Address - Phone:772-589-3186
Practice Address - Fax:561-388-3689
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36006207P00000X
FLME94013207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3332827Medicaid
TNP00255397OtherRAILROAD MEDICARE
KY64109127Medicaid
TN4108165OtherBCBS
KY64109127Medicaid
TN3332827Medicaid