Individual
DEBORAH O'BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-4778
(601) 984-5420
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-4778
(601) 984-5420
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20887
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09173054
—
MS
05
—
134259404
—
TX
01
—
P00795732
RAILROAD MEDICARE
MS
Enumeration date
06/13/2006
Last updated
02/13/2014
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