Provider Demographics
NPI:1487325619
Name:BRYANT, FRANKLIN JORDAN IV
Entity type:Individual
Prefix:MR
First Name:FRANKLIN
Middle Name:JORDAN
Last Name:BRYANT
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 TAYLOR RD UNIT 103
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-8318
Mailing Address - Country:US
Mailing Address - Phone:561-479-8624
Mailing Address - Fax:
Practice Address - Street 1:1500 CENTREPARK BLVD APT 720
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7470
Practice Address - Country:US
Practice Address - Phone:800-530-5093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW405819171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor