Provider Demographics
NPI:1437142437
Name:BENNETT, ROBIN RAY (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:RAY
Last Name:BENNETT
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 1:301 4TH ST STE 30105
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8420
Mailing Address - Country:US
Mailing Address - Phone:318-483-1961
Mailing Address - Fax:318-483-1964
Practice Address - Street 1:201 4TH ST STE 5A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8421
Practice Address - Country:US
Practice Address - Phone:318-483-1961
Practice Address - Fax:318-483-1964
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014865207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1366072Medicaid
LA1366072Medicaid
LAB89602Medicare UPIN