Provider Demographics
NPI:1518936723
Name:RICHERT,SR, ALBERT WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:WARREN
Last Name:RICHERT,SR
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 1:600 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5052
Mailing Address - Country:US
Mailing Address - Phone:337-527-6371
Mailing Address - Fax:337-528-9616
Practice Address - Street 1:600 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5052
Practice Address - Country:US
Practice Address - Phone:337-527-6371
Practice Address - Fax:337-528-9616
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1135534Medicaid
LA5N452Medicare ID - Type Unspecified
LAE77954Medicare UPIN