Provider Demographics
NPI:1053852624
Name:STRUB, RICHARD LESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LESTER
Last Name:STRUB
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 1:529 ESLANADE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70100-2016
Mailing Address - Country:US
Mailing Address - Phone:504-945-0264
Mailing Address - Fax:
Practice Address - Street 1:529 ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70116-2016
Practice Address - Country:US
Practice Address - Phone:504-945-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAR2721174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist