Provider Demographics
NPI:1972506541
Name:BRYAN, JOSEPH M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
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 1:4048 EVANS AVE
Mailing Address - Street 2:STE 303
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9390
Mailing Address - Country:US
Mailing Address - Phone:239-332-5344
Mailing Address - Fax:239-332-7246
Practice Address - Street 1:4048 EVANS AVE
Practice Address - Street 2:STE 303
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9390
Practice Address - Country:US
Practice Address - Phone:239-332-5344
Practice Address - Fax:239-332-7246
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060770207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14711OtherBSFL NASCO
FL370203100OtherMEDICAID GENERIC HMO
FL14711OtherBSFL
FL370203100OtherMEDIPASS
FL008001069OtherCIGNA PPO
FL14711OtherBSFL OUT OF STATE
FL14711ZOtherMEDICARE SECONDARY
FL790532OtherAETNA
FL050027899OtherMEDICARE RAILROAD
FL14711ZOtherHOPE HOSPICE
FL0867335OtherCIGNA HMO
FL14711OtherBSFL HEALTH OPT
FL278295OtherAVMED HMO
FL370203100OtherCMS
FL370203100OtherMEDICAID CROSSOVER
FL370203100Medicaid
FL14711ZOtherHOPE HOSPICE