Kenneth R. Bryant, M.D.

Key facts

NPI

1790770899

Entity type

Individual (NPI type 1)

Primary specialty

Urology Physician 208800000X

License

ME47531 (FL)

Practice address

620 10TH Street N.
St Petersburg, FL 33705-1407

Phone

(727) 824-7146

Fax

(727) 824-7119

NPI assigned

Sep 14, 2005

Sex

Male

Sole proprietor

No

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Suncoast Medical Clinic LLC Multi-Specialty Clinic/Center · St Petersburg, FL · NPI 1497866537
  NPD (past)
• Suncoast Medical Clinic LLC Clinical Medical Laboratory · St Petersburg, FL · NPI 1649397662
  NPD (past)
• Suncoast Medical Clinic LLC Durable Medical Equipment & Medical Supplies · St Petersburg, FL · NPI 1760664882
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 28, 2012.

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356652800000",
    "number": "1790770899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12868",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337332868",
            "telephone_number": "727-824-8357",
            "fax_number": "727-824-3132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 10TH STREET N.",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337051407",
            "telephone_number": "727-824-7146",
            "fax_number": "727-824-7119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYANT",
        "first_name": "KENNETH",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2012-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "FL",
            "license": "ME47531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043205900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

• Jessica Schletter Bruzzichesi, PA-C
• Foster Curtis Bryan, M.D.
• Andrew G Bryant, OTA
• Christian Bryant
• Deborah Bryant
• Nancy Y. Bryant, M.D.
• Nhari Bryant
• Patricia A Bryant
• Eva Catherine Bryce, BSW
• Nicole M Bryson, PTA

All providers in St Petersburg, FL · Urology Physician in Florida