Provider Demographics
NPI:1720278385
Name:LEBERT, BRAD WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:WAYNE
Last Name:LEBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 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:985-327-1938
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD202598207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1508179Medicaid
LA331899YXUAMedicare PIN
LA1508179Medicaid
LAP01291434Medicare PIN
LA331899YH5NMedicare PIN