Provider Demographics
NPI:1548218969
Name:MCCANN, BRYAN CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:CLARK
Last Name:MCCANN
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 1:424 NORTH WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351
Mailing Address - Country:US
Mailing Address - Phone:318-253-8136
Mailing Address - Fax:318-253-5198
Practice Address - Street 1:424 NORTH WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351
Practice Address - Country:US
Practice Address - Phone:318-253-8136
Practice Address - Fax:318-253-5198
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11407208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
10129OtherBLUE CROSS
LA1111520Medicaid
10129OtherBLUE CROSS
LA1111520Medicaid