| Dr Bryan Vyverberg Md, Pllc | |
|
8990 Lorraine Rd Gulfport MS 39503-4176 | |
| (228) 331-3310 | |
| (228) 284-1608 |
| Full Name | Dr Bryan Vyverberg Md, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 8990 Lorraine Rd, Gulfport, Mississippi |
| Authorized Official Name and Position | Bryan Vyverberg (OWNER) |
| Authorized Official Contact | 2283313310 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Bryan Vyverberg Md, Pllc 8990 Lorraine Rd Gulfport MS 39503-4176 Ph: (228) 331-3310 | Dr Bryan Vyverberg Md, Pllc 8990 Lorraine Rd Gulfport MS 39503-4176 Ph: (228) 331-3310 |
| NPI Number | 1639523277 |
|---|---|
| Provider Enumeration Date | 04/20/2016 |
| Last Update Date | 04/20/2016 |
| Medicare PECOS PAC ID | 0446543201 |
|---|---|
| Medicare Enrollment ID | O20160801002293 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639523277 | NPI | - | NPPES |
| 06322869 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 22206 (Mississippi) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 22206 (Mississippi) | Primary |
| Provider Name | Bryan Vyverberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740272723 PECOS PAC ID: 1052604824 Enrollment ID: I20160801002531 |
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