Healthcare Provider Details

I. General information

NPI: 1093848657
Provider Name (Legal Business Name): BRYAN A. LEBEAN,SR,MD,APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/29/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 MOSS ST SUITE B
LAFAYETTE LA
70501-1274
US

IV. Provider business mailing address

2930 MOSS ST SUITE B
LAFAYETTE LA
70501-1274
US

V. Phone/Fax

Practice location:
  • Phone: 337-261-0559
  • Fax: 337-261-0076
Mailing address:
  • Phone: 337-261-0559
  • Fax: 337-261-0076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberL022124
License Number StateLA

VIII. Authorized Official

Name: DR. BRYAN A LEBEAN SR.
Title or Position: OWNER
Credential: M.D.
Phone: 337-261-0559