Provider Demographics
NPI:1467407577
Name:BOEDEFELD, ROBYN LYNN (MD)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:LYNN
Last Name:BOEDEFELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-765-5864
Mailing Address - Fax:225-765-2013
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 701
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-765-5864
Practice Address - Fax:225-765-2013
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23808207RC0200X
VA0101239729207RP1001X
LAMD.202182207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009991735Medicaid
ALP00267754OtherRAILROAD MEDICARE
LA1167584Medicaid
VA010293171Medicaid
AL051528036OtherBLUE CROSS
AL051528036Medicare ID - Type Unspecified
AL009991735Medicaid
VA010293171Medicaid