Individual
DR. THORNTON E BRYAN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 E PARKCENTER BLVD, BOISE, ID 83706-6528
(208) 381-6500
(208) 381-6505
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
(615) 597-5075
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M12455
ID
207Q00000X
Family Medicine Physician
MD.204465
LA
207Q00000X
Family Medicine Physician
MD0000027731
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003038788
BCBS OF TN
TN
05
—
05829798
—
MS
05
—
2158082
—
LA
05
—
3804377
—
TN
Enumeration date
08/17/2005
Last updated
09/26/2014
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