Healthcare Provider Details

I. General information

NPI: 1235163627
Provider Name (Legal Business Name): BRENT K COMBS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTANTIN BLVD
BATON ROUGE LA
70809-3489
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-374-1410
  • Fax: 225-374-1616
Mailing address:
  • Phone: 225-526-0006
  • Fax: 225-765-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberDO.025843
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberMD.025843
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO.025843
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: