Provider Demographics
NPI:1831127786
Name:JENNINGS, BRYAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:T
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:500 SOUTH UNIVERSITY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5314
Mailing Address - Country:US
Mailing Address - Phone:501-664-3914
Mailing Address - Fax:501-664-5246
Practice Address - Street 1:500 SOUTH UNIVERSITY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5314
Practice Address - Country:US
Practice Address - Phone:501-664-3914
Practice Address - Fax:501-664-5246
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE47762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161444001Medicaid
AR5N606Medicare PIN
AR161444001Medicaid