1306009832 NPI number — WILLIAM S BRASTED PHD APC

Table of content: (NPI 1629394606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306009832 NPI number — WILLIAM S BRASTED PHD APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM S BRASTED PHD APC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306009832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3520 GENERAL DEGAULLE DR
Provider Second Line Business Mailing Address:
STE 4098
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70114-6757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-362-8046
Provider Business Mailing Address Fax Number:
504-362-2215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3520 GENERAL DEGAULLE DR
Provider Second Line Business Practice Location Address:
STE 4098
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70114-6757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-362-8046
Provider Business Practice Location Address Fax Number:
504-362-2215
Provider Enumeration Date:
07/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MURRAY
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
504-362-8046

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  470 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com