Provider Demographics
NPI:1063787349
Name:BRAUD, REBECCA (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BRAUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 STELLY LN STE 3
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5650
Mailing Address - Country:US
Mailing Address - Phone:337-528-7316
Mailing Address - Fax:337-528-7884
Practice Address - Street 1:1327 STELLY LN STE 3
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5650
Practice Address - Country:US
Practice Address - Phone:337-528-7316
Practice Address - Fax:337-528-7884
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine