Provider Demographics
NPI:1265480503
Name:ELDREDGE, BRYTTON A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYTTON
Middle Name:A
Last Name:ELDREDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BRYTTON
Other - Middle Name:A
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:109 RUE FOUNTAINE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5744
Mailing Address - Country:US
Mailing Address - Phone:337-266-9820
Mailing Address - Fax:337-266-9822
Practice Address - Street 1:109 RUE FOUNTAINE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5744
Practice Address - Country:US
Practice Address - Phone:337-266-9820
Practice Address - Fax:337-266-9822
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA48901Medicaid
LAI25828Medicare UPIN