Provider Demographics
NPI:1679896658
Name:BRELAND, BRYAN ASHLEY I (MIL TECH)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ASHLEY
Last Name:BRELAND
Suffix:I
Gender:M
Credentials:MIL TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 APP SLADE RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-8744
Mailing Address - Country:US
Mailing Address - Phone:228-222-1330
Mailing Address - Fax:
Practice Address - Street 1:85 APP SLADE RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8744
Practice Address - Country:US
Practice Address - Phone:228-222-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty