Individual
DR. BRANDON KEITH HIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12895 HIGHWAY 90, SUITE H, LULING, LA 70070-2249
(985) 331-9400
(985) 331-9401
Mailing address
12895 HIGHWAY 90, SUITE H, LULING, LA 70070-2249
(985) 331-9400
(985) 331-9401
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.204623
LA
207Q00000X
Family Medicine Physician
PGY.2-LSUNO
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05652823
—
MS
05
—
1505978
—
LA
Enumeration date
05/18/2007
Last updated
06/11/2013
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