Organization
MICHAEL J BRYAN MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN C MOYER (CHIEF FINANCIAL OFFICER)
(928) 778-1251
Entity
Organization
Contact information
Practice address
3251 N WINDSONG DR, PRESCOTT VALLEY, AZ 86314-1222
(928) 772-2582
(928) 772-2383
Mailing address
47 N FRENCH DR, PRESCOTT, AZ 86303-6247
(928) 778-1251
(928) 778-7834
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134374
APIPA
AZ
05
—
134374
—
AZ
01
—
7135706
AETNA
AZ
01
—
AZ0449300
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
07/05/2006
Last updated
06/21/2018
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