Provider Demographics
NPI:1770574709
Name:BRYAN, JOHN DEARING (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DEARING
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7171 S YALE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6367
Mailing Address - Country:US
Mailing Address - Phone:918-481-6630
Mailing Address - Fax:918-481-6698
Practice Address - Street 1:7171 S YALE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6367
Practice Address - Country:US
Practice Address - Phone:918-481-6630
Practice Address - Fax:918-481-6698
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2010-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK11755207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100079040AMedicaid
OKD34452Medicare UPIN