Provider Demographics
NPI:1588696355
Name:CRANE-BRYSON, PATRICIA G (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:G
Last Name:CRANE-BRYSON
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 1:1306 US HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-4003
Mailing Address - Country:US
Mailing Address - Phone:731-989-9899
Mailing Address - Fax:731-989-3495
Practice Address - Street 1:1306 US HIGHWAY 45 N
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-4003
Practice Address - Country:US
Practice Address - Phone:731-989-9899
Practice Address - Fax:731-989-3495
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4123134OtherBLUE CROSS/ BLUE SHIELD
TN3067937Medicaid
TNE89497Medicare UPIN
TN3067937Medicare PIN