Provider Demographics
NPI:1376723304
Name:BRYAN, REDFIELD E JR (MD)
Entity Type:Individual
Prefix:
First Name:REDFIELD
Middle Name:E
Last Name:BRYAN
Suffix:JR
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 1:2020 RUE PROVENCE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8361
Mailing Address - Country:US
Mailing Address - Phone:225-938-5438
Mailing Address - Fax:
Practice Address - Street 1:2020 RUE PROVENCE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8361
Practice Address - Country:US
Practice Address - Phone:225-938-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009241208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology