Provider Demographics
NPI:1093779092
Name:BRINGAZE, WALTER L III (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:L
Last Name:BRINGAZE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD STE 8001
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-490-7224
Mailing Address - Fax:225-490-7223
Practice Address - Street 1:7777 HENNESSY BLVD STE 8001
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-490-7224
Practice Address - Fax:225-490-7223
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017225208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1354716Medicaid
MS00111813Medicaid
LAB65211Medicare UPIN
LA54360Medicare ID - Type UnspecifiedLA MEDICARE NUMBER