Individual
JOHN PHILIP BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
225 CROSSLAKE DR, EVANSVILLE, IN 47715-8198
(812) 477-1558
(812) 488-4669
Mailing address
323S 18TH AVE, STURGEON BAY, WI 54235-1401
(920) 743-5566
(920) 746-3515
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
5601002612
MI
363AS0400X
Surgical Physician Assistant
Primary
99039830A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19788
PRIORITY HEALTH
MI
01
—
383450619
COMMUNITY CHOICE BILLING
MI
Enumeration date
07/29/2005
Last updated
08/24/2015
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