Healthcare Provider Details

I. General information

NPI: 1578190294
Provider Name (Legal Business Name): ANDREA LEMUS BRUMLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15770 PAUL VEGA MD DR
HAMMOND LA
70403-1475
US

IV. Provider business mailing address

1501 KINGS HWY # SURGERY
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-7430
  • Fax: 985-230-7431
Mailing address:
  • Phone: 318-626-0617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number353707
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: