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General NPI Number Information
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NPI Number | 1629259478
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Entity Type | Individual
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Provider Name | GERALD KANE O'BRYAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 1990 INDUSTRIAL BLVD
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City | HOUMA
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State | LA
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Zip | 70363-7055
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Country | US
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Telephone | 985-868-9300
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Fax | 985-851-0053
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Provider Business Mailing Address
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Address Line | 3650 LOYOLA DR APT 108
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City | KENNER
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State | LA
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Zip | 70065-5431
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Country | US
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Telephone | 504-467-8771
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 201218
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 201218
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License Number State | LA
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