Individual
BRYCE THOMAS LORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7000 CHAD COLLEY BLVD, FORT SMITH, AR 72916-6024
(479) 308-2243
(478) 431-5387
Mailing address
7000 CHAD COLLEY BLVD, FORT SMITH, AR 72916-6024
(479) 308-2243
(479) 431-5387
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
602AH0340
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1082722960
TRICARE
IA
Enumeration date
06/04/2022
Last updated
06/04/2022
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