Individual
BRANDI SPARKS BASSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
17199 SPRING RANCH RD STE 200, LIVINGSTON, LA 70754-2900
(225) 686-4960
(225) 686-4961
Mailing address
PO BOX 3087, HAMMOND, LA 70404-3087
(985) 686-4960
(225) 686-4961
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
203013
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1077887
—
LA
Enumeration date
02/27/2008
Last updated
12/07/2022
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