Provider Demographics
NPI:1124202486
Name:BRYAN J BIENVENU MD
Entity Type:Organization
Organization Name:BRYAN J BIENVENU MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENVENU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-767-1311
Mailing Address - Street 1:LOUISIANA HEMATOLOGY ONCOLOGY ASSOC
Mailing Address - Street 2:4950 ESSEN LANE
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LOUISIANA HEMATOLOGY ONCOLOGY ASSOC
Practice Address - Street 2:4950 ESSEN LANE
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809
Practice Address - Country:US
Practice Address - Phone:225-767-1311
Practice Address - Fax:225-767-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022546332900000X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932309OtherOTHER ID NUMBER