Provider Demographics
NPI:1265278857
Name:HEARD, BRYAN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JOHN
Last Name:HEARD
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 1:5 MUNSON ROAD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-5540
Mailing Address - Country:US
Mailing Address - Phone:860-679-2640
Mailing Address - Fax:860-679-1474
Practice Address - Street 1:5 MUNSON ROAD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-5540
Practice Address - Country:US
Practice Address - Phone:860-679-2640
Practice Address - Fax:860-679-1474
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT76636390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program