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General NPI Number Information
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NPI Number | 1528035888
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Entity Type | Individual
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Provider Name | GREGORY W BRYAN DPM
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Gender | Male
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 07/21/2011
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Provider Practice Location Address
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Address Line | 385 BERT KOUNS BLDG. 200
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City | SHREVEPORT
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State | LA
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Zip | 71106-8158
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Country | US
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Telephone | 318-687-8447
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Fax | 318-687-9950
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Provider Business Mailing Address
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Address Line | 385 BERT KOUNS BLDG. 200
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City | SHREVEPORT
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State | LA
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Zip | 71106-8158
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Country | US
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Telephone | 318-687-8447
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Fax | 318-687-9950
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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 | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | PD067R
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License Number State | LA
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