1528200862 NPI number — DR. BRYAN J. DUFRENE

Table of content: (NPI 1528200862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528200862 NPI number — DR. BRYAN J. DUFRENE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. BRYAN J. DUFRENE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528200862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3742 HIGHWAY 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RACELAND
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70394-3141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-537-7187
Provider Business Mailing Address Fax Number:
985-537-7188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3742 HIGHWAY 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RACELAND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70394-3141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-537-7187
Provider Business Practice Location Address Fax Number:
985-537-7188
Provider Enumeration Date:
04/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DUFRENE
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
985-537-7187

Provider Taxonomy Codes

  • Taxonomy code: 111NX0800X , with the licence number:  656 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2183A . This is a "BLUE CROSS/BLUE SHEILD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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