Provider Demographics
NPI:1215594866
Name:BRAUD, GLENN MICHAEL JR (LAC)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:MICHAEL
Last Name:BRAUD
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 S I 10 SERVICE RD W STE 208
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-7431
Mailing Address - Country:US
Mailing Address - Phone:504-650-0027
Mailing Address - Fax:
Practice Address - Street 1:4300 S I 10 SERVICE RD W STE 208
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7431
Practice Address - Country:US
Practice Address - Phone:504-650-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA312357171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist