Individual
KYLE BRUYNINCKX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 ELLINGTON DR, RAYVILLE, LA 71269-3632
(318) 661-0220
Mailing address
117 ELLINGTON DR, RAYVILLE, LA 71269-3632
(318) 376-2189
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD203484
LA
208000000X
Pediatrics Physician
MD203484
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1052558
—
LA
Enumeration date
05/14/2008
Last updated
02/09/2021
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