Provider Demographics
NPI:1538133988
Name:LABORDE, RICHARD SUPPLE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SUPPLE
Last Name:LABORDE
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 1:424 W MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5547
Mailing Address - Country:US
Mailing Address - Phone:337-478-0511
Mailing Address - Fax:
Practice Address - Street 1:424 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5547
Practice Address - Country:US
Practice Address - Phone:337-478-0511
Practice Address - Fax:337-478-5644
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA21104207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA050031853OtherRAILROAD MEDICARE PIN
LA1992879Medicaid
LA050031853OtherRAILROAD MEDICARE PIN
F89760Medicare UPIN