Provider Demographics
NPI:1194739987
Name:BRYANT, TANYA I (MD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:I
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 200TH ST SW
Mailing Address - Street 2:STE 208
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6077
Mailing Address - Country:US
Mailing Address - Phone:425-775-2066
Mailing Address - Fax:425-775-5306
Practice Address - Street 1:6101 200TH ST SW
Practice Address - Street 2:STE 208
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6077
Practice Address - Country:US
Practice Address - Phone:425-775-2066
Practice Address - Fax:425-775-5306
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8431090Medicaid
WA0199256OtherL & I
WA8431090Medicaid
WA0199256OtherL & I