Provider Demographics
NPI:1003898362
Name:ROUGEAU, ROBIN ANN (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ANN
Last Name:ROUGEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SOUTH RYAN ST
Mailing Address - Street 2:#101
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-439-0762
Mailing Address - Fax:337-436-8862
Practice Address - Street 1:555 SOUTH RYAN ST
Practice Address - Street 2:#101
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-439-0762
Practice Address - Fax:337-436-8862
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL016281207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1353574Medicaid
B62483Medicare UPIN
LA1353574Medicaid