Healthcare Provider Details

I. General information

NPI: 1730239708
Provider Name (Legal Business Name): LORI A. MCBRIDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 306
BATON ROUGE LA
70808-4365
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD # A11
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-6834
  • Fax: 225-765-5543
Mailing address:
  • Phone: 225-526-0013
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number200135
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: