Provider Demographics
NPI:1598036683
Name:ROBERT ANCIRA, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT ANCIRA, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANCIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-891-8503
Mailing Address - Street 1:1325 AMELIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3625
Mailing Address - Country:US
Mailing Address - Phone:504-891-8503
Mailing Address - Fax:504-891-9428
Practice Address - Street 1:1325 AMELIA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3625
Practice Address - Country:US
Practice Address - Phone:504-891-8503
Practice Address - Fax:504-891-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0121372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1164739Medicaid
LA50501Medicare PIN
LA1164739Medicaid