Provider Demographics
NPI:1649052689
Name:DR BRAD W LEBERT MD LLC
Entity type:Organization
Organization Name:DR BRAD W LEBERT MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-327-1987
Mailing Address - Street 1:100 S VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3244
Mailing Address - Country:US
Mailing Address - Phone:337-304-9365
Mailing Address - Fax:
Practice Address - Street 1:1550 OCHSNER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8192
Practice Address - Country:US
Practice Address - Phone:985-327-1987
Practice Address - Fax:985-327-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty