Provider Demographics
NPI:1932121795
Name:BIENVENU, BRYAN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JAMES
Last Name:BIENVENU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4950 ESSEN LANE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3482
Mailing Address - Country:US
Mailing Address - Phone:225-767-1311
Mailing Address - Fax:225-766-0218
Practice Address - Street 1:4950 ESSEN LANE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3482
Practice Address - Country:US
Practice Address - Phone:225-767-1311
Practice Address - Fax:225-766-0218
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA22546207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1490351Medicaid
G57885Medicare UPIN
LA1490351Medicaid
4N270DD21Medicare PIN