Provider Demographics
NPI:1255967113
Name:BRYAN, LEAH (MD, MSC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MD, MSC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:COLLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MSC
Mailing Address - Street 1:50 CENTRACARE DR
Mailing Address - Street 2:
Mailing Address - City:LONG PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56347-2100
Mailing Address - Country:US
Mailing Address - Phone:320-732-2131
Mailing Address - Fax:
Practice Address - Street 1:50 CENTRACARE DR
Practice Address - Street 2:
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-2100
Practice Address - Country:US
Practice Address - Phone:320-732-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-22
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN74463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine