Provider Demographics
NPI:1326042037
Name:CLARDY, BRYAN HOLLAN (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:HOLLAN
Last Name:CLARDY
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 1:612 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4702
Mailing Address - Country:US
Mailing Address - Phone:479-785-2431
Mailing Address - Fax:
Practice Address - Street 1:1301 S E ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4716
Practice Address - Country:US
Practice Address - Phone:479-785-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-2745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7848374OtherAETNA
OK100143000AMedicaid
LA1637041Medicaid
AR2220866OtherUNITED HEALTHCARE
2674666001OtherCIGNA
AR5M245OtherBLUE CROSS/BLUE SHIELD
02090005200OtherQUALCHOICE
MS02450298Medicaid
AR146720001Medicaid
080184879OtherRAILROAD MEDICARE
080184879OtherRAILROAD MEDICARE
AR146720001Medicaid
MS02450298Medicaid