Provider Demographics
NPI:1003808155
Name:BRIAN CLINIC, L.L.P.
Entity Type:Organization
Organization Name:BRIAN CLINIC, L.L.P.
Other - Org Name:BRIAN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-445-7355
Mailing Address - Street 1:425 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8131
Mailing Address - Country:US
Mailing Address - Phone:318-445-7355
Mailing Address - Fax:318-487-8035
Practice Address - Street 1:425 SCOTT ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8131
Practice Address - Country:US
Practice Address - Phone:318-445-7355
Practice Address - Fax:318-487-8035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACN8468OtherRAILROAD MEDICARE
LA1018520Medicaid
LA=========0OtherBLUE CROSS BLUE SHIELD LA
LACN8468OtherRAILROAD MEDICARE
LA1018520Medicaid
LA=========0OtherBLUE CROSS BLUE SHIELD LA