Provider Demographics
NPI:1427039726
Name:BRYAN, HERBIE SEYMOUR (MD)
Entity type:Individual
Prefix:
First Name:HERBIE
Middle Name:SEYMOUR
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 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTENTION PNS CREDENTIALING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6946
Mailing Address - Fax:
Practice Address - Street 1:2701 CHURCH ST
Practice Address - Street 2:STE D
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4422
Practice Address - Country:US
Practice Address - Phone:843-234-6888
Practice Address - Fax:843-234-6889
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101019207RP1001X
SC32149207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC321495Medicaid
NC1427039726Medicaid
NC132NOOtherBCBS
NC89132NOMedicaid
P00202187OtherRAIL ROAD MEDICARE
NCNCM280AMedicare PIN
NC2008123AMedicare PIN