Provider Demographics
NPI:1023009263
Name:DEWITT, ROBERT CHANCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHANCE
Last Name:DEWITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 PRESCOTT RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3900
Mailing Address - Country:US
Mailing Address - Phone:318-442-0106
Mailing Address - Fax:
Practice Address - Street 1:3311 PRESCOTT RD STE 312
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3984
Practice Address - Country:US
Practice Address - Phone:318-528-1998
Practice Address - Fax:318-767-9931
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14951R208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1158739Medicaid
LA1E7268OtherMEDICARE ID
LA4F236Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE