Anon, Jack Bryant

Anon, Jack Bryant is an individual health care provider with primary practice located at 1645 W 8Th St , Erie PA 16505-5007. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngic Allergy, which is considered as his primary health care specialty. Anon, Jack Bryant can be contacted via phone (814) 864-9994.

Contact Information

Primary practice address
1645 W 8Th St Erie PA 16505-5007
Phone: (814) 864-9994
Fax: (814) 866-2655
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngic Allergy 207YX0602X MD035571E Pennsylvania

Profile Details

NPI number 1104877265
LBN Legal business name Anon, Jack Bryant
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 13th, 2006
Last updated Apr 27th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104877265 NPPES
Pennsylvania MEDICAID 0010476830001

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