Basic Information
| Provider Information | |||||||||
| NPI: | 1114025830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BJORNSTAD | ||||||||
| FirstName: | BRYAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 945 BETHESDA DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437010801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404544788 | ||||||||
| FaxNumber: | 7404506157 | ||||||||
| Practice Location | |||||||||
| Address1: | 751 FOREST AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405889120 | ||||||||
| FaxNumber: | 7405889140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 04/08/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 36376 | TN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 35090768 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084S0012X | 35090768 | OH | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0702090003 | 01 | TN | PALMETTO GBA DME | OTHER | 2803505 | 05 | OH | MEDICAID | 130025744 | 01 | TN | RAILROAD MEDICARE | OTHER | 3874219 | 05 | TN | MEDICAID |