Provider Demographics
NPI:1972614238
Name:BRY, JOHN DAVID (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:BRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:925-932-6330
Mailing Address - Fax:925-932-0139
Practice Address - Street 1:350 30TH ST STE 210
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3425
Practice Address - Country:US
Practice Address - Phone:510-832-6131
Practice Address - Fax:510-832-6169
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG795132086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G795130Medicaid
CA00G795132Medicare PIN
CA770000540Medicare PIN
CA00G795130Medicaid