Provider Demographics
NPI:1083613756
Name:BRIGNAC, DONALD VERON (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:VERON
Last Name:BRIGNAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12525 PERKINS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1907
Mailing Address - Country:US
Mailing Address - Phone:225-765-4256
Mailing Address - Fax:225-765-4034
Practice Address - Street 1:5428 ODONOVAN DR STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4387
Practice Address - Country:US
Practice Address - Phone:225-330-0480
Practice Address - Fax:225-330-0482
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA017224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA080130382OtherRAILROAD MEDICARE
LA1350257Medicaid
LA50983DX80Medicare PIN
LA080130382OtherRAILROAD MEDICARE