Provider Demographics
NPI:1679593487
Name:BRYANT, TARA M (MB)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:M
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10288
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-0288
Mailing Address - Country:US
Mailing Address - Phone:205-502-5650
Mailing Address - Fax:205-502-5513
Practice Address - Street 1:1600 CARRAWAY BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35234-1913
Practice Address - Country:US
Practice Address - Phone:205-502-6000
Practice Address - Fax:205-502-5513
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00016578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F32165Medicare UPIN