Provider Demographics
NPI:1649296682
Name:KRULL, BRYAN JAMES (DO)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:JAMES
Last Name:KRULL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3025 SHRINE RD STE 450
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4787
Mailing Address - Country:US
Mailing Address - Phone:912-264-6133
Mailing Address - Fax:912-354-7569
Practice Address - Street 1:3025 SHRINE RD STE 450
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520
Practice Address - Country:US
Practice Address - Phone:912-264-6133
Practice Address - Fax:912-267-1915
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA81198207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology