Basic Information
| Provider Information | |||||||||
| NPI: | 1174554398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYANT | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8501 ARLINGTON BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039706464 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8501 ARLINGTON BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039706464 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 10/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | A80125 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | D0082026 | MD | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | MD044561 | DC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | 2010-01313 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | 0101260383 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.