# DR BRYAN VYVERBERG MD, PLLC

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

## Provider details

- **NPI number:** 1639523277
- **Authorized official:** DR. BRYAN VYVERBERG MD (OWNER)
- **Authorized official phone:** (228) 331-3310

## Contact information

- **Practice address:** 8990 LORRAINE RD, GULFPORT, MS 39503-4176
- **Practice address phone:** (228) 331-3310
- **Practice address fax:** (228) 284-1608
- **Mailing address:** 8990 LORRAINE RD, GULFPORT, MS 39503-4176
- **Mailing address phone:** (228) 331-3310
- **Mailing address fax:** (228) 284-1608

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0800X | Psychiatry Physician | 22206 | MS | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | 22206 | MS | Yes |

## Other

- **Enumeration date:** 04/20/2016
- **Last updated:** 04/20/2016