Individual
JOHN R BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000308A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26126818
—
CO
05
—
74676512
—
NM
05
—
918394
—
AZ
Enumeration date
12/08/2006
Last updated
01/03/2008
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