Provider Demographics
NPI:1821042607
Name:CLASEN, STACEY BRADFORD (MD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:BRADFORD
Last Name:CLASEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LEIGH
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:515 WESTBANK EXPY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5644
Mailing Address - Country:US
Mailing Address - Phone:504-366-7233
Mailing Address - Fax:504-366-0686
Practice Address - Street 1:515 WESTBANK EXPY
Practice Address - Street 2:SUITE 7
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5644
Practice Address - Country:US
Practice Address - Phone:504-366-7233
Practice Address - Fax:504-366-0686
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.025608207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1043583Medicaid
LA1043583Medicaid
LA4J724C867Medicare PIN