Provider Demographics
NPI:1336601459
Name:BRYANT, RICHARD DANIEL
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DANIEL
Last Name:BRYANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W MONROE ST STE 600A
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2079
Mailing Address - Country:US
Mailing Address - Phone:517-954-5632
Mailing Address - Fax:
Practice Address - Street 1:950 W MONROE ST STE 600A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2079
Practice Address - Country:US
Practice Address - Phone:517-954-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator