Doctor Name: | BRYANT S EDWARDS |
NPI Number: | 1760745079 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 0102203711 |
Business Practice Address: | 3551 Roger Brooke Dr Brooke Army Medical Center Fort Sam Houston, TX - 782344504 |
Business Phone Number: | 2109168666 |
Business Fax Number: | 2109168712 |
Mailing Address: | 3551 Roger Brooke Dr, Brooke Army Medical Center FORT SAM HOUSTON |
State: | TX |
Postal Code: | 782344504 |
Phone Number: | 2109168666 |
Fax Number: | 2109168712 |
NPI Enumeration Date: | 06/21/2012 |
NPI Last Update Date: | 07/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 0102203711 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |