Provider Demographics
NPI:1588825160
Name:MCMYNE, ROBERT CARL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CARL
Last Name:MCMYNE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:CARL
Other - Last Name:MCMYNE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4320 HOUMA BLVD
Mailing Address - Street 2:FL 6
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2961
Mailing Address - Country:US
Mailing Address - Phone:504-503-4109
Mailing Address - Fax:504-503-4103
Practice Address - Street 1:4320 HOUMA BLVD
Practice Address - Street 2:FL 6
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2961
Practice Address - Country:US
Practice Address - Phone:504-503-4109
Practice Address - Fax:504-503-4103
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203467208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1096776Medicaid
LA1096776Medicaid