Provider Demographics
NPI:1235343187
Name:DAVIS, BRANDON L (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:L
Last Name:DAVIS
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 1:1 HOLYLAND DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-1055
Mailing Address - Country:US
Mailing Address - Phone:504-888-7771
Mailing Address - Fax:504-888-9388
Practice Address - Street 1:4224 HOUMA BLVD STE 430
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2937
Practice Address - Country:US
Practice Address - Phone:504-888-7771
Practice Address - Fax:504-888-9388
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD201500207W00000X
MS21052207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1014621Medicaid
MS03183371Medicaid
MS302I185882Medicare PIN
LA1014621Medicaid