Provider Demographics
NPI:1023208675
Name:PINKNEY, BRODERICK LETREY (MD)
Entity Type:Individual
Prefix:
First Name:BRODERICK
Middle Name:LETREY
Last Name:PINKNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:2810 EAST CAUSEWAY APPROACH
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70449-3502
Practice Address - Country:US
Practice Address - Phone:985-875-2713
Practice Address - Fax:504-373-6103
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2040692084P0800X
LAGETP.LSU.P2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1006751Medicaid
MS06076223Medicaid
MS06076223Medicaid