Provider Demographics
NPI:1750959284
Name:BRAUD, MARY ELLEN HODGES (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN HODGES
Last Name:BRAUD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10101 PARK ROWE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1685
Mailing Address - Country:US
Mailing Address - Phone:225-769-2200
Mailing Address - Fax:833-756-2680
Practice Address - Street 1:10101 PARK ROWE AVE STE 200
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1685
Practice Address - Country:US
Practice Address - Phone:504-842-3980
Practice Address - Fax:833-756-2680
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2024-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA327807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant