Provider Demographics
NPI:1295717791
Name:BRYANT, THERON GERMAINE (DO)
Entity type:Individual
Prefix:DR
First Name:THERON
Middle Name:GERMAINE
Last Name:BRYANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAG-J, UNIT 45013
Mailing Address - Street 2:BOX 3009
Mailing Address - City:APO
Mailing Address - State:JAPAN
Mailing Address - Zip Code:AP
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USAG-J
Practice Address - Street 2:USA MEDDAC - JAPAN
Practice Address - City:APO
Practice Address - State:JAPAN
Practice Address - Zip Code:AP
Practice Address - Country:JP
Practice Address - Phone:263-4127
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine