Provider Demographics
NPI:1982725701
Name:BRYANT, DORSAY D
Entity Type:Individual
Prefix:DR
First Name:DORSAY
Middle Name:D
Last Name:BRYANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 N ACADIAN THRUWAY W
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-1857
Mailing Address - Country:US
Mailing Address - Phone:225-356-6768
Mailing Address - Fax:
Practice Address - Street 1:1820 N ACADIAN THRUWAY W
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-1857
Practice Address - Country:US
Practice Address - Phone:225-356-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02335207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1080454Medicaid
LAB62217Medicare UPIN
LA50165Medicare ID - Type Unspecified