Individual
CYNTHIA BLACKWELL BRYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 WEST COLLEGE BOULEVARD, SUITE G, NICEVILLE, FL 32578-1049
(850) 897-1700
(850) 897-1792
Mailing address
1001 COLLEGE BLVD W, SUITE G, NICEVILLE, FL 32578-1099
(850) 897-1700
(850) 897-1792
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME80397
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110233921
RAILROAD MEDICARE
FL
05
—
259143000
—
FL
01
—
35711
BLUE CROSS/BLUE SHIELD FL
FL
Enumeration date
03/09/2006
Last updated
05/30/2015
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