Provider Demographics
NPI:1184616112
Name:BRUNSON, JOAN ELIZABETH (MD)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ELIZABETH
Last Name:BRUNSON
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 1:425 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8131
Mailing Address - Country:US
Mailing Address - Phone:318-445-7355
Mailing Address - Fax:318-487-8035
Practice Address - Street 1:425 SCOTT ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8131
Practice Address - Country:US
Practice Address - Phone:318-445-7355
Practice Address - Fax:318-487-8035
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA61-17296207QA0401X
LA017125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
720477182OtherVARIOUS INSURANCES
LA1337820Medicaid
080169582OtherRAILROAD MEDICARE
LA1337820Medicaid
080169582OtherRAILROAD MEDICARE