Provider Demographics
NPI:1568426807
Name:BRAR, RAVINDERJIT S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVINDERJIT
Middle Name:S
Last Name:BRAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3425 NORTH BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3608
Mailing Address - Country:US
Mailing Address - Phone:318-473-1921
Mailing Address - Fax:318-473-1922
Practice Address - Street 1:3425 NORTH BLVD
Practice Address - Street 2:STE A
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3608
Practice Address - Country:US
Practice Address - Phone:318-473-1921
Practice Address - Fax:318-473-1922
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2019-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA11856R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1688126Medicaid
LA1688126Medicaid
LA5Y151CM85Medicare PIN