Provider Demographics
NPI:1811943459
Name:WALROD, BRYANT JAMES (MD)
Entity type:Individual
Prefix:
First Name:BRYANT
Middle Name:JAMES
Last Name:WALROD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-3600
Mailing Address - Fax:614-293-2910
Practice Address - Street 1:2835 FRED TAYLOR DR STE 2000
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1552
Practice Address - Country:US
Practice Address - Phone:614-293-3600
Practice Address - Fax:614-293-2910
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45877207Q00000X
OH35081526207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1811943459Medicaid
H93127Medicare UPIN
WI1081 73-601Medicare PIN
H93127Medicare UPIN