Provider Demographics
NPI:1457316283
Name:BRALY, PATRICIA S (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:BRALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CHEROKEE ROSE LANE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-893-0911
Mailing Address - Fax:985-875-7565
Practice Address - Street 1:606 WEST 12TH STREET
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-893-2252
Practice Address - Fax:985-893-6636
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10321R207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1988677Medicaid
A47224Medicare UPIN
LA5U273Medicare ID - Type Unspecified