Provider Demographics
NPI:1013108042
Name:HIDER, BRANDACE J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDACE
Middle Name:J
Last Name:HIDER
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 1:2820 NAPOLEON AVE STE 950
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-8203
Mailing Address - Country:US
Mailing Address - Phone:504-897-4242
Mailing Address - Fax:
Practice Address - Street 1:2820 NAPOLEON AVE STE 950
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-8203
Practice Address - Country:US
Practice Address - Phone:504-897-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1508284Medicaid