Individual
DR. BRYAN WAYNE RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1449 E BERT KOUN LOOP STE 101, SHREVEPORT, LA 71105-5663
(318) 681-4282
Mailing address
7821 YOUREE DR, SHREVEPORT, LA 71105-5505
(318) 213-3668
(318) 213-3670
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DPM.PD290R
LA
213E00000X
Podiatrist
PD290R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1436127
—
LA
Enumeration date
06/21/2005
Last updated
06/17/2025
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