Provider Demographics
NPI:1851487417
Name:BRYANT, THOMAS R (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:BRYANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:DEPT 2043
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-2043
Mailing Address - Country:US
Mailing Address - Phone:205-491-3299
Mailing Address - Fax:205-744-8751
Practice Address - Street 1:3004 ALLISON BONNETT MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2317
Practice Address - Country:US
Practice Address - Phone:205-491-3299
Practice Address - Fax:205-744-8751
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11392207Q00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051532844Medicaid
ALC72034Medicare UPIN
AL0515-32844Medicare ID - Type Unspecified