MEDICARE: BRYAN A. LEBEAN,SR,MD,APMC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	L022124	LA
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1093848657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYAN A. LEBEAN,SR,MD,APMC

Provider Business Mailing Address
First Line	:	2930 MOSS ST
Second Line	:	SUITE B
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-1274
Country	:	US
Telephone Number	:	337-261-0559
Fax Number	:	337-261-0076

Provider Business Practice Location Address
First Line	:	2930 MOSS ST
Second Line	:	SUITE B
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-1274
Country	:	US
Telephone Number	:	337-261-0559
Fax Number	:	337-261-0076

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRYAN A LEBEAN SR.
Credential	:	M.D.
Telephone Number	:	337-261-0559

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	10/29/2021

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