Healthcare Provider Details

I. General information

NPI: 1740602572
Provider Name (Legal Business Name): BRIAN H. STRAND, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GREENLEAVES BLVD SUITE 11
MANDEVILLE LA
70448-7092
US

IV. Provider business mailing address

200 GREENLEAVES BLVD SUITE 11
MANDEVILLE LA
70448-7092
US

V. Phone/Fax

Practice location:
  • Phone: 985-626-6277
  • Fax: 985-626-6209
Mailing address:
  • Phone: 985-626-6277
  • Fax: 985-626-6209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number09430R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number09430R
License Number StateLA

VIII. Authorized Official

Name: BRIAN HENRY STRAND
Title or Position: PRESIDENT
Credential: MD
Phone: 985-626-6277