Provider Demographics
NPI:1013156439
Name:RANEY, AMANDA BRADSHAW (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BRADSHAW
Last Name:RANEY
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 1:7045 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5108
Mailing Address - Country:US
Mailing Address - Phone:318-798-3763
Mailing Address - Fax:318-797-0645
Practice Address - Street 1:7045 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5108
Practice Address - Country:US
Practice Address - Phone:318-798-3763
Practice Address - Fax:318-797-0645
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200647208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4N859DG96Medicare PIN