DR. BRYAN CHRISTOPHER FAGAN (NPI# 1669683405) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669683405 |
| Entity Type | Individual |
| Full Name | DR. BRYAN CHRISTOPHER FAGAN |
| Credential | M.D. |
| Practice Address |
4381 S Eason Blvd Suite 102 Tupelo MS 38801-6583 |
| Mailing Address |
499 Gloster Creek Vlg Ste G1 Tupelo MS 38801-4751 |
| Practice Telephone | 6623776700 |
| Practice Fax Number | 6623776706 |
| Mailing Telephone | 6623776700 |
| Mailing Fax Number | 6623776706 |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2019-08-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | 20606 | MS | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | AU5009697-756 | MS | Allopathic & Osteopathic Physicians |
| N | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
20606 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 02629297 | 05 | |
| MS | 00359815 | 05 | |
| MS | MEDICARE ID | 302I205607 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306979786 | Bryan Ignatius Fagan | Physician Assistant | 500 Upper Chesapeake Dr, Emergency Dept, Bel Air, MD 21014-4324 | 2007-03-14 |
| Street Address |
4381 S EASON BLVD SUITE 102 |
| City | TUPELO |
| State | MS |
| Zip Code | 38801-6583 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548259013 | Donna Elaine Wesley | Specialist/Technologist | 4381 S Eason Blvd, Tupelo, MS 38801-6583 | 2005-10-18 |
| 1013462258 | Millicent Mcalilly | Social Worker | 4381 S Eason Blvd, Suite 301, Tupelo, MS 38801-6583 | 2016-08-17 |
| 1679943401 | Jeffrey Dews | Specialist/Technologist | 4381 S Eason Blvd, Tupelo, MS 38801-6583 | 2015-10-06 |
| 1013385715 | North Mississippi Medical Center, Inc. | Internal Medicine | 4381 S Eason Blvd, Suite 302, Tupelo, MS 38801-6583 | 2015-09-11 |
| 1588046155 | Devin Fancher | Nurse Practitioner | 4381 S Eason Blvd, Suite 302, Tupelo, MS 38801-6583 | 2015-06-19 |
| 1205249471 | Lori Hall Forrester | Nurse Practitioner | 4381 S Eason Blvd, Suite 302, Tupelo, MS 38801-6583 | 2014-06-05 |
| 1003233727 | Michelle Pruitt | Specialist/Technologist | 4381 S Eason Blvd, Tupelo, MS 38801-6583 | 2014-03-19 |
| 1518393354 | North Mississippi Medical Center, Inc. | Neurological Surgery | 4381 S Eason Blvd, Suite 302, Tupelo, MS 38801-6583 | 2013-09-25 |
| 1497091730 | North Mississippi Medical Center, Inc | Nurse Practitioner | 4381 S Eason Blvd, Suite 201, Tupelo, MS 38801-6583 | 2012-12-13 |
| 1790034254 | Lee Ann Stewart | Physical Therapist | 4381 S Eason Blvd, Tupelo, MS 38801 | 2012-08-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194339275 | Friendship, LLC | Pharmacy | 4123 W Main St, Tupelo, MS 38801 | 2020-09-04 |
| 1003443458 | Nicole Sherice Taylor | Nurse Practitioner | 845 South Gloster Street, Tupelo, MS 38801 | 2020-03-25 |
| 1821556838 | Wilco Healthcare of North Mississippi, Pllc | Point of Service | 1514 Co Rd 41, Tupelo, MS 38801 | 2019-03-08 |
| 1821565235 | Stephanie K Cagle | Nurse Practitioner | 218 S Thomas St Ste 120-121, Tupelo, MS 38801 | 2018-10-24 |
| 1073092326 | Lauren Parrish | Nurse Practitioner | 1573 Medical Park Circle, Tupelo, MS 38801 | 2018-08-08 |
| 1467948687 | North Mississippi Medcial Center, Inc. | Nurse Practitioner | 990 S Madison St Ste 2, Tupelo, MS 38801 | 2018-07-11 |
| 1043700933 | Hooks Diabetes & Medicine Clinic | Non-Pharmacy Dispensing Site | 2610 Traceland Drive, Ste A, Tupelo, MS 38801 | 2018-05-16 |
| 1073035903 | Annette C Riddle | Counselor | 1004 Eisenhower Drive, Tupelo, MS 38801 | 2017-07-12 |
| 1548709678 | Jaime Summers | Nurse Practitioner | 2780 West Jackson St, Tupelo, MS 38801 | 2017-02-22 |
| 1073975611 | Heath Bryan Coleman, Dds of Mississippi II, Pllc | Dentist | 1168 Cross Creek Drive, Tupelo, MS 38801 | 2016-03-23 |
| Find all providers in zip 38801 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477817799 | Matthew A Miller | Orthopaedic Surgery | 1211 South Gloster St, Suite A, Tupelo, MS 38801 | 2012-07-02 |
| 1053622498 | Taylor Phillips Mathis | Orthopaedic Surgery | 1211 S Gloster St, Suite A, Tupelo, MS 38801 | 2010-06-30 |
| 1174768287 | George Karl Van Osten IIi | Orthopaedic Surgery | 4381 South Eason Blvd., Suite 303, North Mississippi Sports Medicine and Orthopaedic Clini, Tupelo, MS 38801 | 2008-12-04 |
| 1619139474 | Rowland M. Roberson | Orthopaedic Surgery | 1211 South Gloster, Suite A, Tupelo, MS 38801 | 2008-07-01 |
| 1245258193 | Tupelo Orthopedic Clinic Pa | Orthopaedic Surgery | 808 Garfield St, Tupelo, MS 38801-5749 | 2006-07-18 |
| 1790755320 | Orthopaedic Institute of North Mississippi, LLC | Orthopaedic Surgery | 499 Gloster Creek Vlg Ste G1, Tupelo, MS 38801-4751 | 2006-01-25 |
| 1457350282 | James Lafayette White | Orthopaedic Surgery | 1464 Medical Park Cir, Tupelo, MS 38801-6595 | 2005-07-14 |
| 1639553506 | Specialty Orthopedic Group of Mississippi Pllc | Orthopaedic Surgery | 1211 S Gloster St Ste A, Tupelo, MS 38801-6535 | 2015-07-10 |
| 1023458452 | Jeremy Caleb Adams | Orthopaedic Surgery | 1211 S Gloster St Ste A, Tupelo, MS 38801-6548 | 2013-06-29 |
| 1982949046 | North Mississippi Medical Center Services LLC | Orthopaedic Surgery | 808 Garfield St, Tupelo, MS 38801-5749 | 2012-11-30 |
| Find all providers in TUPELO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.