Provider Demographics
NPI:1508076456
Name:BRAUD, TERRY JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:JOHN
Last Name:BRAUD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 BLUEBONNET BLVD STE 3200
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7831
Mailing Address - Country:US
Mailing Address - Phone:225-939-4455
Mailing Address - Fax:225-408-7980
Practice Address - Street 1:8080 BLUEBONNET BLVD STE 3200
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7831
Practice Address - Country:US
Practice Address - Phone:225-924-2424
Practice Address - Fax:225-408-7980
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10429363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant