Provider Demographics
NPI:1013302116
Name:BRYAN, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3738 CYPRESS CLUB DR
Mailing Address - Street 2:VILLA D403
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-2483
Mailing Address - Country:US
Mailing Address - Phone:704-529-4437
Mailing Address - Fax:704-973-0899
Practice Address - Street 1:3738 CYPRESS CLUB DR
Practice Address - Street 2:VILLA D403
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-2483
Practice Address - Country:US
Practice Address - Phone:704-529-4437
Practice Address - Fax:704-973-0899
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC10436246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical TechnologistGroup - Multi-Specialty