Individual
DWIGHT E BRYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5757 MONCLOVA RD, STE 1, MAUMEE, OH 43537-1863
(419) 897-8417
(419) 897-8418
Mailing address
5757 MONCLOVA RD, STE 1, MAUMEE, OH 43537-1863
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
340037326
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0704054
—
OH
01
—
080188792
RAILROAD MEDICARE
OH
01
—
470855160
FED TAX
—
Enumeration date
09/27/2005
Last updated
05/18/2017
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