Individual
DR. BRYAN CHRISTOPHER FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
499 GLOSTER CREEK VLG, STE G1, TUPELO, MS 38801-4751
(662) 377-2663
(662) 377-6706
Mailing address
499 GLOSTER CREEK VLG, STE G1, TUPELO, MS 38801-4751
(662) 377-2663
(662) 377-6706
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
20606
MS
207X00000X
Orthopaedic Surgery Physician
AU5009697-756
MS
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
20606
MS
207XX0801X
Orthopaedic Trauma Physician
20606
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00359815
—
MS
05
—
02629297
—
MS
01
—
302I205607
MEDICARE ID
MS
Enumeration date
05/24/2007
Last updated
01/26/2023
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