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Individual
GARY BRANDT
Active
Individual
GARY BRANDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
017647
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1359670
—
LA
01
—
4331551460
BLUE CROSS
LA
01
—
930114663
RRM
LA
Enumeration date
07/29/2005
Last updated
10/13/2009
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