Provider Demographics
NPI:1609842947
Name:BRYANT, SUSAN J (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JEANINE
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:29301 N DIXIE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445
Mailing Address - Country:US
Mailing Address - Phone:985-871-4114
Mailing Address - Fax:985-871-4130
Practice Address - Street 1:3434 HOUMA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4201
Practice Address - Country:US
Practice Address - Phone:504-635-2601
Practice Address - Fax:504-324-2078
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0217832081P2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1691496Medicaid
LA1691496Medicaid
LA5Y252Medicare ID - Type Unspecified