Provider Demographics
NPI:1225247455
Name:BLAPPERT, BRADLEY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:MICHAEL
Last Name:BLAPPERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:539 BERTRAND DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-5556
Mailing Address - Country:US
Mailing Address - Phone:337-294-1230
Mailing Address - Fax:833-749-0347
Practice Address - Street 1:539 BERTRAND DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-5556
Practice Address - Country:US
Practice Address - Phone:337-294-1230
Practice Address - Fax:833-749-0347
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA2022254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1225247455OtherNPI
LA1239364Medicaid
LA1239364Medicaid