Individual
BRANT P DOMANGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MEDICAL CENTER DR, SLIDELL, LA 70461-5520
(985) 646-5189
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
310574
LA
207P00000X
Emergency Medicine Physician
LL38466
SC
Other
Enumeration date
06/15/2015
Last updated
10/22/2018
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