Basic Information
| Provider Information | |||||||||
| NPI: | 1558317891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRYANT | ||||||||
| FirstName: | COLIN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 E LAUREL RD | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407418601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068773931 | ||||||||
| FaxNumber: | 6068773978 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 E 9TH ST | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407411204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068786520 | ||||||||
| FaxNumber: | 6068773978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 02/02/2017 | ||||||||
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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 | 207L00000X | 33513 | KY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 35.069868 | OH | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 61-1427889 | 01 | KY | BLUEGRASS FAMILY HEALTH | OTHER | 61-1427889 | 01 | KY | UHC | OTHER | 64039233 | 05 | KY | MEDICAID | P00309186 | 01 | KY | RRMCR | OTHER | C20361 | 01 | KY | CUMBERLAND HEALTHCARE INC | OTHER | 61-1427889 | 01 | KY | CHA | OTHER | 030670000 | 01 | KY | BLACK LUNG | OTHER | 000000476589 | 01 | KY | ANTHEM | OTHER | 50010606 | 01 | KY | PASSPORT HEALTH PLAN | OTHER | 61-1427889 | 01 | KY | TRICARE | OTHER | 61-1427889 | 01 | KY | HUMANA | OTHER |