Organization
HEATHER BRONAUGH, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HEATHER RAE BRONAUGH M.D. (PRESIDENT/OWNER)
(985) 781-9002
Entity
Organization
Contact information
Practice address
1051 GAUSE BLVD STE 260, SLIDELL, LA 70458-2992
(985) 781-9002
(985) 781-0200
Mailing address
1051 GAUSE BLVD STE 260, SLIDELL, LA 70458-2992
(985) 781-9002
(985) 781-0200
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
025950
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144211632
INDIVIDUAL NPI
LA
05
—
1420271
—
LA
01
—
DF0787
RAILROAD MEDICARE GROUP NUMBER
LA
01
—
P00336861
RAILROAD MEDICARE PIN
LA
Enumeration date
07/30/2007
Last updated
11/23/2010
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