Provider Demographics
NPI:1164690129
Name:CRIST, ROBERT LOUIS JR
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LOUIS
Last Name:CRIST
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W BAYOU PKWY APT 801
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3382
Mailing Address - Country:US
Mailing Address - Phone:504-473-1142
Mailing Address - Fax:337-232-7829
Practice Address - Street 1:110 W BAYOU PKWY
Practice Address - Street 2:801
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3378
Practice Address - Country:US
Practice Address - Phone:504-473-1142
Practice Address - Fax:337-232-7829
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies