Provider Demographics
NPI:1912976176
Name:BRYCH, JAMES ROBERT (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:BRYCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:ROBERT
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:DULUTH CLINIC, INTERNAL MEDICINE
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-3337
Mailing Address - Fax:218-786-8226
Practice Address - Street 1:400 E 3RD ST
Practice Address - Street 2:DULUTH CLINIC, INTERNAL MEDICINE
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1951
Practice Address - Country:US
Practice Address - Phone:218-786-3337
Practice Address - Fax:218-786-8226
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9444363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN622652300Medicaid
MN622652300Medicaid
P19041Medicare UPIN