Individual
BRYAN JOHANNES VEKOVIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
450 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7228
(318) 375-3733
(318) 675-3734
Mailing address
450 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7228
(318) 675-3733
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
L023263
LA
207WX0109X
Neuro-ophthalmology Physician
L023263
LA
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
L023263
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0238TU
BLUE CROSS BLUE SHIELD
TX
05
—
1495867
—
LA
01
—
154644202
TEXAS MEDICAID
TX
01
—
170085727
GROUP NPI #
LA
01
—
180044593
RAILROAD MEDICARE
LA
Enumeration date
06/08/2006
Last updated
05/20/2020
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