Provider Demographics
NPI:1649842345
Name:BRYCE W BEARD MEDICAL LLC
Entity type:Organization
Organization Name:BRYCE W BEARD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-288-3619
Mailing Address - Street 1:605 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8143
Mailing Address - Country:US
Mailing Address - Phone:318-769-7200
Mailing Address - Fax:318-442-1901
Practice Address - Street 1:605 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8143
Practice Address - Country:US
Practice Address - Phone:318-769-7200
Practice Address - Fax:318-442-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty