Healthcare Provider Details

I. General information

NPI: 1356427199
Provider Name (Legal Business Name): BRANDON K BEAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 CHEROKEE ROSE LN
COVINGTON LA
70433-7201
US

IV. Provider business mailing address

217 CHEROKEE ROSE LANE
COVINGTON LA
70433
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-0911
  • Fax: 985-875-7565
Mailing address:
  • Phone: 985-893-0911
  • Fax: 985-875-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number202995
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number19272
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: