Provider Demographics
NPI:1093848657
Name:BRYAN A. LEBEAN,SR,MD,APMC
Entity Type:Organization
Organization Name:BRYAN A. LEBEAN,SR,MD,APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEBEAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-261-0559
Mailing Address - Street 1:2930 MOSS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-1274
Mailing Address - Country:US
Mailing Address - Phone:337-261-0559
Mailing Address - Fax:337-261-0076
Practice Address - Street 1:2930 MOSS ST
Practice Address - Street 2:SUITE B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-1274
Practice Address - Country:US
Practice Address - Phone:337-261-0559
Practice Address - Fax:337-261-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
LAL022124261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty