Healthcare Provider Details

I. General information

NPI: 1538401393
Provider Name (Legal Business Name): BRENNA BUSSART RAMOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 GAUSE BLVD
SLIDELL LA
70458-2939
US

IV. Provider business mailing address

1001 GAUSE BLVD
SLIDELL LA
70458-2939
US

V. Phone/Fax

Practice location:
  • Phone: 985-280-2200
  • Fax:
Mailing address:
  • Phone: 985-280-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number207453
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.207453
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: