Provider Demographics
NPI:1053865360
Name:ROBIN DALE M.D. LLC
Entity Type:Organization
Organization Name:ROBIN DALE M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-270-8783
Mailing Address - Street 1:8369 FLORIDA BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-7862
Mailing Address - Country:US
Mailing Address - Phone:225-270-8783
Mailing Address - Fax:
Practice Address - Street 1:8369 FLORIDA BLVD STE 5
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7862
Practice Address - Country:US
Practice Address - Phone:225-270-8783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1048445Medicaid
LA1048445Medicaid