MEDICARE: MORGAN BRAUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	310688	LA

General Provider Information

NPI Number	:	1124502893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN BRAUD

Provider Business Mailing Address
First Line	:	8832 LOCHNESS AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-8172
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 LEE DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4954
Country	:	US
Telephone Number	:	225-302-5757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2018
Last Update Date	:	01/21/2021

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Directions to “ MORGAN BRAUD ” Practice Location

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