Provider Demographics
NPI:1306806534
Name:BRYAN, ROY GORDON (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:GORDON
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5836 LONG BRAKE TRL
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2622
Mailing Address - Country:US
Mailing Address - Phone:952-829-5708
Mailing Address - Fax:
Practice Address - Street 1:5836 LONG BRAKE TRL
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2622
Practice Address - Country:US
Practice Address - Phone:952-829-5708
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29203207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A95993Medicare UPIN