Provider Demographics
NPI:1144770074
Name:CARL J RICHARD, M.D.
Entity Type:Organization
Organization Name:CARL J RICHARD, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND CODING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:AXTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-962-1157
Mailing Address - Street 1:204 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-3920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:KAPLAN
Practice Address - State:LA
Practice Address - Zip Code:70548-3920
Practice Address - Country:US
Practice Address - Phone:337-643-8583
Practice Address - Fax:337-643-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB65545Medicare UPIN