Individual
MICHAEL ANTHONY BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
305 W JACKSON ST STE 400, CARBONDALE, IL 62901-1474
(618) 351-4972
(618) 351-4973
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085002238
IL
363AS0400X
Surgical Physician Assistant
2005019359
MO
363AS0400X
Surgical Physician Assistant
2162
TN
Other
Enumeration date
05/08/2006
Last updated
08/14/2023
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