Provider Demographics
NPI:1851497275
Name:BRYN, RANDY D (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:D
Last Name:BRYN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2551 GREENWOOD RD
Mailing Address - Street 2:STE 210
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3905
Mailing Address - Country:US
Mailing Address - Phone:318-635-0834
Mailing Address - Fax:318-636-2331
Practice Address - Street 1:2551 GREENWOOD RD
Practice Address - Street 2:STE 210
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3905
Practice Address - Country:US
Practice Address - Phone:318-635-0834
Practice Address - Fax:318-636-2331
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-06-21
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Provider Licenses
StateLicense IDTaxonomies
LA03907R207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1311189Medicaid
LA290003340OtherRR MEDICARE
LA1311189Medicaid