Individual
DR. JACK BRYANT ANON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1645 W 8TH ST, ERIE, PA 16505-5007
(814) 864-9994
(814) 866-2655
Mailing address
1645 W 8TH ST, ERIE, PA 16505-5007
(814) 864-9994
(814) 866-2655
Taxonomy
Speciality
Code
Description
License number
State
207YX0602X
Otolaryngic Allergy Physician
Primary
MD035571E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010476830001
—
PA
Enumeration date
05/13/2006
Last updated
04/27/2021
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