Provider Demographics
NPI:1326040858
Name:BAROOTES, BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:BAROOTES
Suffix:
Gender:M
Credentials:MD
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 123453
Mailing Address - Street 2:DEPT 3453
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-3453
Mailing Address - Country:US
Mailing Address - Phone:337-494-2772
Mailing Address - Fax:337-494-2928
Practice Address - Street 1:1525 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8849
Practice Address - Country:US
Practice Address - Phone:337-494-6767
Practice Address - Fax:337-494-6750
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13512R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1429155Medicaid
LAP00212785OtherRAILROAD MEDICARE
LA5H399F808Medicare ID - Type Unspecified
LA1429155Medicaid