Fagan, Bryan Christopher
Fagan, Bryan Christopher is an individual health care provider with primary practice located at 499 Gloster Creek Vlg Ste G1, Tupelo MS 38801-4751. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Sports Medicine, Allopathic & Osteopathic Physicians / Orthopaedic Trauma. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Fagan, Bryan Christopher can be contacted via phone (662) 377-2663.Contact Information
Primary practice address
499 Gloster Creek Vlg Ste G1
Tupelo MS 38801-4751
Phone: (662) 377-2663
Fax: (662) 377-6706
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | AU5009697-756 | Mississippi |
Allopathic & Osteopathic Physicians / Sports Medicine | 207XX0005X | 20606 | Mississippi |
Allopathic & Osteopathic Physicians / Orthopaedic Trauma | 207XX0801X | 20606 | Mississippi |
Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 20606 | Mississippi |
Profile Details
NPI number | 1669683405 |
---|---|
LBN Legal business name | Fagan, Bryan Christopher |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | May 24th, 2007 |
Last updated | Jan 26th, 2023 - about 2 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1669683405 | NPPES |
Mississippi | Other | 302I205607 | MEDICARE ID |
Mississippi | MEDICAID | 02629297 | MEDICARE ID |
Mississippi | MEDICAID | 00359815 | MEDICARE ID |
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