Provider Demographics
NPI:1568661437
Name:SEELY, BRYAN PHILIP (PA)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:PHILIP
Last Name:SEELY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 TULANE AVE
Mailing Address - Street 2:TW-4
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2600
Mailing Address - Country:US
Mailing Address - Phone:504-988-3290
Mailing Address - Fax:504-988-6216
Practice Address - Street 1:1415 TULANE AVE
Practice Address - Street 2:TW-4
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-3290
Practice Address - Fax:504-988-6216
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA200083363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1029475Medicaid
LA5DB49PC37Medicare PIN