Provider Demographics
NPI:1073574489
Name:ROBICHEAUX, JAMES GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GLENN
Last Name:ROBICHEAUX
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 1:5412 DIJON DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4315
Mailing Address - Country:US
Mailing Address - Phone:225-766-4999
Mailing Address - Fax:225-766-6050
Practice Address - Street 1:5412 DIJON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4315
Practice Address - Country:US
Practice Address - Phone:225-766-4999
Practice Address - Fax:225-766-6050
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16372174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1389111Medicaid
LA5J675Medicare ID - Type Unspecified
LA1389111Medicaid