Provider Demographics
NPI:1306859152
Name:LEBAS, ROBERT C (PD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:LEBAS
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6618
Mailing Address - Country:US
Mailing Address - Phone:337-948-9827
Mailing Address - Fax:337-948-6553
Practice Address - Street 1:1615 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6618
Practice Address - Country:US
Practice Address - Phone:337-948-9827
Practice Address - Fax:337-948-6553
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1266396Medicaid