Provider Demographics
NPI:1821052754
Name:LEBEAN, BRYAN ANTHONY SR (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ANTHONY
Last Name:LEBEAN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2930 MOSS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-1274
Mailing Address - Country:US
Mailing Address - Phone:337-261-0559
Mailing Address - Fax:337-261-0076
Practice Address - Street 1:2930 MOSS ST
Practice Address - Street 2:SUITE B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-1274
Practice Address - Country:US
Practice Address - Phone:337-261-0559
Practice Address - Fax:337-261-0076
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA022124207RS0012X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1656542Medicaid
LAG06429Medicare UPIN
LA1656542Medicaid