Provider Demographics
NPI:1396748604
Name:BRYAN, DAVID G (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:BRYAN
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 1:312 GRAMMONT ST
Mailing Address - Street 2:STE 300
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7403
Mailing Address - Country:US
Mailing Address - Phone:318-388-4030
Mailing Address - Fax:318-324-3334
Practice Address - Street 1:312 GRAMMONT ST
Practice Address - Street 2:STE 300
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7403
Practice Address - Country:US
Practice Address - Phone:318-388-4030
Practice Address - Fax:318-324-3334
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016816207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1357251Medicaid
LA1357251Medicaid
LAB62775Medicare UPIN