Provider Demographics
NPI:1275593675
Name:BRATTON, BERT R (MD)
Entity Type:Individual
Prefix:
First Name:BERT
Middle Name:R
Last Name:BRATTON
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 1:985 ROBERT BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458
Mailing Address - Country:US
Mailing Address - Phone:985-646-2303
Mailing Address - Fax:985-690-8334
Practice Address - Street 1:985 ROBERT BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-646-2303
Practice Address - Fax:985-690-8334
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD011991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA50517Medicare ID - Type UnspecifiedMEDICARE ID