Individual
DR. HEATHER RAE BRONAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1051 GAUSE BLVD STE 410, SLIDELL, LA 70458-2995
(985) 280-9002
(985) 781-0200
Mailing address
1051 GAUSE BLVD STE 410, SLIDELL, LA 70458-2995
(985) 280-9002
(985) 781-0200
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
025950
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1420271
—
LA
01
—
1801020433
NPI SMH PHYSICIAN NETWORK
LA
01
—
5CR31
MEDICARE GROUP NUMBER
LA
01
—
P00336861
RAILROAD MEDICARE
LA
Enumeration date
11/02/2005
Last updated
01/22/2020
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