Provider Demographics
NPI:1619915733
Name:LOEWER, BRADLEY H (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:H
Last Name:LOEWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 123453 DEPT 3453
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-0001
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:1525 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8849
Practice Address - Country:US
Practice Address - Phone:337-494-6767
Practice Address - Fax:337-494-6750
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD026567207Q00000X
LA026567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1066273Medicaid
LAMD.026567OtherSTATE LICENSE
LAI38059Medicare UPIN