Individual
CAROLYN K BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1100 CENTRAL AVE SE, PMG EMERGENCY MEDICINE, ALBUQUERQUE, NM 87106-4930
(505) 841-1125
(505) 841-1737
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5654
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
9717
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000L5158
—
NM
Enumeration date
10/03/2006
Last updated
03/24/2016
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