Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 10321R | LA |
NPI | 1457316283 |
---|---|
Provider Name | Patricia S Braly |
First Address | Covington, LA 70433 |
Second Address | Covington, LA 70433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 02/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1988677 | (05) | LA |
A47224 | (02) |