Provider Demographics
NPI:1982703575
Name:ROBERT C ALBRECHT MD
Entity type:Organization
Organization Name:ROBERT C ALBRECHT MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-536-2605
Mailing Address - Street 1:147 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:LA
Mailing Address - Zip Code:70084-6001
Mailing Address - Country:US
Mailing Address - Phone:985-536-2605
Mailing Address - Fax:985-536-8388
Practice Address - Street 1:147 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084-6001
Practice Address - Country:US
Practice Address - Phone:985-536-2605
Practice Address - Fax:985-536-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1527301Medicaid
LA1527301Medicaid