Healthcare Provider Details

I. General information

NPI: 1700842564
Provider Name (Legal Business Name): WASHINGTON G. B. BRYAN SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 PRYTANIA ST
NEW ORLEANS LA
70115-3733
US

IV. Provider business mailing address

1 ISLAND CLUB CT
NEW ORLEANS LA
70131-3372
US

V. Phone/Fax

Practice location:
  • Phone: 504-891-3711
  • Fax: 504-891-6353
Mailing address:
  • Phone: 504-392-8107
  • Fax: 504-891-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD05226R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD05226R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: