Provider Demographics
NPI:1154324549
Name:BRAUD, LAWRENCE L (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:L
Last Name:BRAUD
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 1:8080 BLUEBONNET BLVD
Mailing Address - Street 2:STE 2222
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7828
Mailing Address - Country:US
Mailing Address - Phone:225-769-2222
Mailing Address - Fax:225-757-8061
Practice Address - Street 1:8080 BLUEBONNET BLVD
Practice Address - Street 2:STE 2222
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7828
Practice Address - Country:US
Practice Address - Phone:225-769-2222
Practice Address - Fax:225-757-8061
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010945174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1150452Medicaid
LA1150452Medicaid
LA5J287Medicare ID - Type Unspecified