MEDICARE: DR. LAURA RICHARD BRAHAM MD

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	207Q00000X	Family Medicine Physician	25270	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770552556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA RICHARD BRAHAM MD

Provider Business Mailing Address
First Line	:	150 RODEO DRIVE
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70570-6948
Country	:	US
Telephone Number	:	337-942-5706
Fax Number	:	337-942-2644

Provider Business Practice Location Address
First Line	:	3921 I 49 S SERVICE RD
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70570-0758
Country	:	US
Telephone Number	:	337-942-5706
Fax Number	:	337-942-2644

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	12/13/2010

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