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General NPI Number Information
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NPI Number | 1174969133
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Entity Type | Individual
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Provider Name | BRYAN ANTHONY PICOU JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2013
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 1029 KEYSER AVE SUITE G
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City | NATCHITOCHES
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State | LA
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Zip | 71457-6239
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Country | US
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Telephone | 318-352-2971
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Fax | 318-356-0850
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Provider Business Mailing Address
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Address Line | 1029 KEYSER AVE SUITE G
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City | NATCHITOCHES
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State | LA
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Zip | 71457-6239
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Country | US
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Telephone | 318-352-2971
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Fax | 318-356-0850
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD.208184
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License Number State | LA
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