Provider Demographics
NPI:1962772194
Name:BRYSON, THEODORE K (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:K
Last Name:BRYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:T
Other - Middle Name:K
Other - Last Name:BRYSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2207 DEL MAR SCENIC PKWY
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3633
Mailing Address - Country:US
Mailing Address - Phone:858-481-0626
Mailing Address - Fax:
Practice Address - Street 1:2207 DEL MAR SCENIC PKWY
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3633
Practice Address - Country:US
Practice Address - Phone:858-481-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28099207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology