Provider Demographics
NPI:1285685644
Name:THOMPSON, BRADFORD R (MD)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:R
Last Name:THOMPSON
Suffix:
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 1:501 RUE DE SANTE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5400
Mailing Address - Country:US
Mailing Address - Phone:985-652-7880
Mailing Address - Fax:985-652-7883
Practice Address - Street 1:501 RUE DE SANTE
Practice Address - Street 2:SUITE 2
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5400
Practice Address - Country:US
Practice Address - Phone:985-652-7880
Practice Address - Fax:985-652-7883
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15420R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1197483Medicaid
LA4J034Medicare ID - Type Unspecified
LAC33620Medicare UPIN