Provider Information for 1063907301
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BRANDON PERRY
Sex: Male
NPI: 1063907301
Last Updated: 2025-03-21
Certification Date: 2025-03-21
Certification Date: 2025-03-21
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1063907301 | ||||||||||||||||
| Enumeration Date | 2018-06-28 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 13675 COURSEY BLVD APT 1122 BATON ROUGE, LA 70817-1357 United States Phone: 318-589-1839 | Fax: | ||||||||||||||||
| Primary Practice Address | 7855 HOWELL BLVD BATON ROUGE, LA 70807-5256 United States Phone: 225-465-8104 | Fax: | ||||||||||||||||
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