Organization
TRACE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD E BRYANT MD (PRESIDENT/OWNER)
(662) 289-9155
Entity
Organization
Contact information
Practice address
530 VETERANS MEMORIAL DR, KOSCIUSKO, MS 39090-3858
(662) 289-9155
(662) 289-7752
Mailing address
530 VETERANS MEMORIAL DR, KOSCIUSKO, MS 39090-3858
(662) 289-9155
(662) 289-7752
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016283
—
MS
Enumeration date
04/14/2008
Last updated
05/27/2008
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