Basic Information
| Provider Information | |||||||||
| NPI: | 1336769397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARGE | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | OHIOHEALTH DOCTORS HOSPITAL | ||||||||
| Address2: | 5100 WEST BROAD STREET | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145441000 | ||||||||
| FaxNumber: | 6145441745 | ||||||||
| Practice Location | |||||||||
| Address1: | OHIOHEALTH DOCTORS HOSPITAL | ||||||||
| Address2: | 5100 WEST BROAD STREET | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145441000 | ||||||||
| FaxNumber: | 6145441745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2020 | ||||||||
| LastUpdateDate: | 04/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | OH | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.