Provider Demographics
NPI:1831414481
Name:BRYAN, BEAU TAYLOR (MD)
Entity type:Individual
Prefix:DR
First Name:BEAU
Middle Name:TAYLOR
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3600 FOREST DR STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4057
Mailing Address - Country:US
Mailing Address - Phone:803-888-2370
Mailing Address - Fax:803-888-2371
Practice Address - Street 1:3600 FOREST DR STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4057
Practice Address - Country:US
Practice Address - Phone:803-888-2370
Practice Address - Fax:803-888-2371
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCMD36264207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology