Provider Demographics
NPI:1356393904
Name:RONALD W. BRYAN M.D.,P.C.
Entity type:Organization
Organization Name:RONALD W. BRYAN M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-690-7820
Mailing Address - Street 1:9330 PARK WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4309
Mailing Address - Country:US
Mailing Address - Phone:865-690-7820
Mailing Address - Fax:865-539-6262
Practice Address - Street 1:9330 PARK WEST BLVD
Practice Address - Street 2:SUITE #103
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4309
Practice Address - Country:US
Practice Address - Phone:865-690-7820
Practice Address - Fax:865-539-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000013662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3171572Medicaid
TN3171572Medicaid
TN3387919Medicare ID - Type Unspecified