Individual
DR. HEATHER BRACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8001 YOUREE DR, SHREVEPORT, LA 71115-2302
(318) 212-3530
Mailing address
8001 YOUREE DR, SHREVEPORT, LA 71115-2302
(318) 212-3530
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
17685
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04724096
—
MS
05
—
1422835
—
LA
01
—
P00436433
RAILROAD MEDICARE
MS
01
—
P00462159
RAILROAD MEDICARE
MS
Enumeration date
08/07/2006
Last updated
10/02/2015
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