Provider Demographics
NPI:1831133743
Name:BRYAN, TIM (MD)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4365 E PECOS RD
Mailing Address - Street 2:BLDG 14, SUITE 134
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8053
Mailing Address - Country:US
Mailing Address - Phone:480-840-9155
Mailing Address - Fax:480-840-9320
Practice Address - Street 1:4365 E PECOS RD
Practice Address - Street 2:SUITE 134
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8053
Practice Address - Country:US
Practice Address - Phone:480-840-9155
Practice Address - Fax:480-840-9320
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ35487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI17021Medicare UPIN