Individual
JULIE BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6507 E STATE BLVD, FORT WAYNE, IN 46815-7026
(260) 486-3300
(260) 486-3600
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01053541A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000358544
ANTHEM
IN
01
—
12156
PHYSICIANS HEALTH PLAN
IN
05
—
200330130
—
IN
01
—
3937240010
MEDICARE DMEPOS
IN
01
—
7318238
AETNA
—
01
—
P00204040
MEDICARE RR
IN
Enumeration date
12/06/2005
Last updated
04/11/2025
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