Provider Demographics
NPI:1043538887
Name:MARIA M BRAUD MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MARIA M BRAUD MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-447-1216
Mailing Address - Street 1:970 S ACADIA RD
Mailing Address - Street 2:STE C
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4978
Mailing Address - Country:US
Mailing Address - Phone:985-447-1216
Mailing Address - Fax:985-447-1218
Practice Address - Street 1:970 S ACADIA RD
Practice Address - Street 2:STE C
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4978
Practice Address - Country:US
Practice Address - Phone:985-447-1216
Practice Address - Fax:985-447-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0230282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1483265Medicaid
LA1483265Medicaid