Healthcare Provider Details

I. General information

NPI: 1821080615
Provider Name (Legal Business Name): BRYAN P BARRILLEAUX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 S RYAN ST
LAKE CHARLES LA
70601-5726
US

IV. Provider business mailing address

643 S RYAN ST
LAKE CHARLES LA
70601-5726
US

V. Phone/Fax

Practice location:
  • Phone: 337-439-2000
  • Fax: 337-439-2025
Mailing address:
  • Phone: 337-439-2000
  • Fax: 337-439-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number017896
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number017896
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: