Healthcare Provider Details

I. General information

NPI: 1124202486
Provider Name (Legal Business Name): BRYAN J BIENVENU MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOUISIANA HEMATOLOGY ONCOLOGY ASSOC 4950 ESSEN LANE
BATON ROUGE LA
70809
US

IV. Provider business mailing address

LOUISIANA HEMATOLOGY ONCOLOGY ASSOC 4950 ESSEN LANE
BATON ROUGE LA
70809
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-1311
  • Fax: 225-767-1335
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number022546
License Number StateLA

VIII. Authorized Official

Name: BRYAN BIENVENU
Title or Position: DOCTOR
Credential:
Phone: 225-767-1311