Healthcare Provider Details

I. General information

NPI: 1457316283
Provider Name (Legal Business Name): PATRICIA S BRALY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 WEST 12TH STREET
COVINGTON LA
70433
US

IV. Provider business mailing address

217 CHEROKEE ROSE LANE
COVINGTON LA
70433
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-2252
  • Fax: 985-893-6636
Mailing address:
  • Phone: 985-893-0911
  • Fax: 985-875-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number10321R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: