Provider Demographics
NPI:1881686558
Name:BRYAN, JOSEPH SHEPARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SHEPARD
Last Name:BRYAN
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 1:7600 N 15TH ST
Mailing Address - Street 2:SUITE 155
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4327
Mailing Address - Country:US
Mailing Address - Phone:602-242-4928
Mailing Address - Fax:602-249-4813
Practice Address - Street 1:7600 N 15TH ST
Practice Address - Street 2:SUITE 155
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4327
Practice Address - Country:US
Practice Address - Phone:602-242-4928
Practice Address - Fax:602-249-4813
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23580207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ18WCKDW04OtherMEDICARE PART B
AZ325127Medicaid
AZ18WCKDW04OtherMEDICARE PART B