Provider Demographics
NPI:1356427199
Name:BEAN, BRANDON K (MD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:K
Last Name:BEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CHEROKEE ROSE LANE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-893-0911
Mailing Address - Fax:985-875-7565
Practice Address - Street 1:217 CHEROKEE ROSE LN
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7201
Practice Address - Country:US
Practice Address - Phone:985-893-0911
Practice Address - Fax:985-875-7565
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202995207RN0300X
MS19272207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1882445Medicaid
LA4N958CT59Medicare PIN