Provider Demographics
NPI:1942567375
Name:BRYANT, LAURIE SUSAN (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:SUSAN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:655 W 8TH ST
Mailing Address - Street 2:1ST FLOOR, CLINICAL CENTER
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-244-3817
Mailing Address - Fax:904-244-4077
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:1ST FLOOR, CLINICAL CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-3817
Practice Address - Fax:904-244-4077
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS13282207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine