Provider Demographics
NPI:1467897348
Name:ROE, RICHARD RATLIFF IV (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:RATLIFF
Last Name:ROE
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:701 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5053
Mailing Address - Country:US
Mailing Address - Phone:337-480-8900
Mailing Address - Fax:337-480-8901
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:BRENT HOUSE ROOM 634
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA#390200000X207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology