# JAB SPORTS MEDICINE & DIRECT PRIMARY CARE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043957657
- **Authorized official:** DR. JOSEEN BRYANT MD, CAQSM, MBA (OWNER/PRESIDENT)
- **Authorized official phone:** (219) 292-4973

## Contact information

- **Practice address:** 5521 W LINCOLN HWY STE 230, CROWN POINT, IN 46307-1097
- **Practice address phone:** (219) 301-1158
- **Practice address fax:** (219) 301-1158
- **Mailing address:** 8049 W 85TH CT, CROWN POINT, IN 46307-8981
- **Mailing address phone:** (219) 292-4973
- **Mailing address fax:** (219) 301-1158

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/16/2022
- **Last updated:** 05/16/2022