Individual
BRYAN SMITH HATHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M D
Contact information
Practice address
7777 HENNESSY BLVD, SUITE 1000, BATON ROUGE, LA 70808-4300
(225) 767-3900
(225) 766-2226
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 765-5727
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
14857R
LA
207RI0011X
Interventional Cardiology Physician
Primary
14857R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060070427
PALMETTO GBA
LA
05
—
1149551
—
LA
01
—
232799
WELLCARE
LA
01
—
2500911
UNITED HEALTH CARE
LA
01
—
5355641
AETNA
LA
Enumeration date
08/10/2005
Last updated
03/24/2021
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