Provider Demographics
NPI:1477550705
Name:KUBRICHT, WILLIAM SAMUEL III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SAMUEL
Last Name:KUBRICHT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7827
Mailing Address - Country:US
Mailing Address - Phone:225-766-8100
Mailing Address - Fax:225-408-6867
Practice Address - Street 1:8080 BLUEBONNET BLVD
Practice Address - Street 2:SUITE 3000
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7827
Practice Address - Country:US
Practice Address - Phone:225-766-8100
Practice Address - Fax:225-408-6867
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2011-10-23
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
LA022659208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1494887Medicaid
LA1494887Medicaid
LAH26830Medicare UPIN