Individual
KEITH G BRYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2805 5TH ST, SUITE 100, RAPID CITY, SD 57701-6003
(605) 719-5700
(605) 719-5701
Mailing address
353 FAIRMONT BLVD, ATTEN MEDICAL STAFF SERVICES, RAPID CITY, SD 57701-6000
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
5987
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00414306
RR MEDICARE
SD
Enumeration date
07/14/2005
Last updated
02/06/2013
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