Provider Demographics
NPI:1447376470
Name:BRYAN, MATTHEW DEAN (AUD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DEAN
Last Name:BRYAN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 TES DR.
Mailing Address - Street 2:
Mailing Address - City:CHOUDRANT
Mailing Address - State:LA
Mailing Address - Zip Code:71227
Mailing Address - Country:US
Mailing Address - Phone:318-257-4764
Mailing Address - Fax:318-257-4492
Practice Address - Street 1:120 ROBINSON HALL
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71272-0001
Practice Address - Country:US
Practice Address - Phone:318-257-4764
Practice Address - Fax:318-257-4492
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5555231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist