Provider Demographics
NPI:1518916915
Name:BOSTICK, ROBERT DOUGLAS III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:BOSTICK
Suffix:III
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 1:3001 DIVISION ST STE 204
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5855
Mailing Address - Country:US
Mailing Address - Phone:504-541-5800
Mailing Address - Fax:504-541-5801
Practice Address - Street 1:3001 DIVISION ST STE 204
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-541-5800
Practice Address - Fax:504-541-5801
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023026207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1483192Medicaid
LA200045552OtherRR MEDICARE INDIVIDUAL
LA1792217OtherMEDICAID GROUP
LACK4990OtherRAILROAD MEDICARE GROUP
LA5B353OtherMEDICARE GROUP
LA1483192Medicaid
LA0418960001Medicare NSC
LA5B353OtherMEDICARE GROUP