Active NPI
Luis Bogran-Reyes, M.D.
- Surgery Physician
- Houma, LA
National Provider Identifier
1124062948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 012553
- Practice address
- 1990 Industrial Blvd
Houma, LA 70363-7055 - Phone
- (985) 868-9300
- Fax
- (985) 851-0053
- NPI assigned
- Jun 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 012553 | LA | Primary |
Addresses
Primary practice location
1990 Industrial Blvd
Houma, LA 70363-7055
Mailing address
1990 Industrial Blvd
Houma, LA 70363-7055
Phone (985) 868-9300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1321605 | Medicaid | LA | |
| 20051204 | Other | LA | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012553 | LA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350432000000",
"number": "1124062948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1990 INDUSTRIAL BLVD",
"city": "HOUMA",
"state": "LA",
"postal_code": "703637055",
"telephone_number": "985-868-9300",
"fax_number": "985-851-0053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1990 INDUSTRIAL BLVD",
"city": "HOUMA",
"state": "LA",
"postal_code": "703637055",
"telephone_number": "985-868-9300",
"fax_number": "985-851-0053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGRAN-REYES",
"first_name": "LUIS",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-15",
"last_updated": "2012-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "LA",
"license": "012553",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1321605",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "20051204",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houma, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.