Provider Demographics
NPI:1538899521
Name:PHAN, BRYSSON (DO)
Entity type:Individual
Prefix:
First Name:BRYSSON
Middle Name:
Last Name:PHAN
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 1:10149 MALPAS PT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6158
Mailing Address - Country:US
Mailing Address - Phone:407-412-8487
Mailing Address - Fax:
Practice Address - Street 1:740 DUNLAWTON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4239
Practice Address - Country:US
Practice Address - Phone:386-763-1000
Practice Address - Fax:386-763-0507
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS22453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine