Individual
DR. JUSTIN R BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, MBA
Contact information
Practice address
11141 PARKVIEW PLAZA DR STE 300, FORT WAYNE, IN 46845-1715
(260) 425-6960
Mailing address
PO BOX 947407, ATLANTA, GA 30394-7407
(941) 917-2600
(941) 917-7884
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
71983
WI
208200000X
Plastic Surgery Physician
DO034726
DC
2086S0122X
Plastic and Reconstructive Surgery Physician
02004908A
IN
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
OS21663
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427363449
—
WI
Enumeration date
08/13/2010
Last updated
05/22/2025
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