Active NPI
Bruce Jackson Bryan, MD
- Surgery Physician
- Pinetop, AZ
National Provider Identifier
1700847050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 20232
- Practice address
- 163 W White Mountain Hwy
Suite D
Pinetop, AZ 85935-2850 - Phone
- (928) 367-1200
- Fax
- (928) 367-1205
- NPI assigned
- Mar 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 20232 | AZ | Primary |
Addresses
Primary practice location
163 W White Mountain Hwy
Suite D
Pinetop, AZ 85935-2850
Mailing address
PO Box 2850
163 White Mountain Hwy Suite D
Pinetop, AZ 85935-2850
Phone (928) 367-1200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20232 | AZ | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187913600000",
"number": "1700847050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2850",
"address_2": "163 WHITE MOUNTAIN HWY SUITE D",
"city": "PINETOP",
"state": "AZ",
"postal_code": "859352850",
"telephone_number": "928-367-1200",
"fax_number": "928-367-1205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "163 W WHITE MOUNTAIN HWY",
"address_2": "SUITE D",
"city": "PINETOP",
"state": "AZ",
"postal_code": "859352850",
"telephone_number": "928-367-1200",
"fax_number": "928-367-1205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRYAN",
"first_name": "BRUCE",
"middle_name": "JACKSON",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-28",
"last_updated": "2007-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "AZ",
"license": "20232",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pinetop, AZ
- Amare Integrated Clinical Services, LLC
- Atr Resource Services
- Barnet Dulaney Perkins Eye Center, PLLC
- Blue Ridge Family Dentistry, PC
- Richard Albert Boatright, DC
- Brooke Lynn Butler, M.S., CCC-SLP
- Carl Peiser, D.D.S.
- Natalie Carroll, PTA
- Changepoint Integrated Health (Woodland Home)
- Code Calm Counseling PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.