Healthcare Provider Details

I. General information

NPI: 1124275250
Provider Name (Legal Business Name): BRYAN A. LEBEAN, SR., M.D., APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 S UNION ST SUITE B
OPELOUSAS LA
70570-5612
US

IV. Provider business mailing address

2930 MOSS STREET SUITE B
LAFAYETTE LA
70501-1242
US

V. Phone/Fax

Practice location:
  • Phone: 337-942-3491
  • Fax: 337-769-7145
Mailing address:
  • Phone: 337-261-0559
  • Fax: 337-769-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number022124
License Number StateLA

VIII. Authorized Official

Name: DR. BRYAN ANTHONY LEBEAN SR.
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 337-261-0559