Provider Demographics
NPI:1508138108
Name:BRYANT, DONALD L JR (PA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:BRYANT
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 W NEW HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:OSBORNE
Mailing Address - State:KS
Mailing Address - Zip Code:67473-2313
Mailing Address - Country:US
Mailing Address - Phone:785-345-2510
Mailing Address - Fax:
Practice Address - Street 1:431 W NEW HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:OSBORNE
Practice Address - State:KS
Practice Address - Zip Code:67473-2313
Practice Address - Country:US
Practice Address - Phone:785-345-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant