Individual
RANDY D BRYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2551 GREENWOOD RD, STE 210, SHREVEPORT, LA 71103-3905
(318) 635-0834
(318) 636-2331
Mailing address
2551 GREENWOOD RD, STE 210, SHREVEPORT, LA 71103-3905
(318) 635-0834
(318) 636-2331
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
03907R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1311189
—
LA
01
—
290003340
RR MEDICARE
LA
Enumeration date
09/15/2006
Last updated
06/21/2021
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