Provider Demographics
NPI:1801851670
Name:BRYAN, THOMAS ORVILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ORVILLE
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1050 LAKES DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2924
Mailing Address - Country:US
Mailing Address - Phone:626-918-6655
Mailing Address - Fax:626-918-6633
Practice Address - Street 1:1135 S SUNSET AVE STE 200
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-918-6655
Practice Address - Fax:626-918-6633
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49736207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG49736HMedicare ID - Type Unspecified
CAA51451Medicare UPIN