Provider Demographics
NPI:1194036137
Name:LEGER, BRYAN JOSEPH (CRNA)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JOSEPH
Last Name:LEGER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5587
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-5587
Mailing Address - Country:US
Mailing Address - Phone:409-838-5214
Mailing Address - Fax:409-838-1946
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:SUITE P3600
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1500
Practice Address - Country:US
Practice Address - Phone:409-838-5214
Practice Address - Fax:409-838-1946
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX783782367500000X
FLARNP9309067367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002524700Medicaid
AL120416Medicaid
P00885439OtherMEDICARE RAILROAD
FLG00EHOtherBLUE CROSS BLUE SHIELD
AL592-12285OtherBLUE CROSS BLUE SHIELD
FL002524700Medicaid