=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356427199
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDON K BEAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 11/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 217 CHEROKEE ROSE LN
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70433-7201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-893-0911
-----------------------------------------------------
Fax | 985-875-7565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 217 CHEROKEE ROSE LANE
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-893-0911
-----------------------------------------------------
Fax | 985-875-7565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 202995
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 19272
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------