Provider Demographics
NPI:1114961786
Name:BRYANT, PATRICIA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4640 JEFFERSON LN NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2116
Mailing Address - Country:US
Mailing Address - Phone:505-883-1259
Mailing Address - Fax:505-883-3020
Practice Address - Street 1:9201 MONTGOMERY BLVD NE STE 301
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2467
Practice Address - Country:US
Practice Address - Phone:505-717-1076
Practice Address - Fax:866-530-1835
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM86-185207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME09276Medicare UPIN