Provider Demographics
NPI:1629496500
Name:ROBERTS, CORY ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:ANTHONY
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1430 TULANE AVE # SL-50
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2632
Mailing Address - Country:US
Mailing Address - Phone:504-988-7809
Mailing Address - Fax:504-988-3971
Practice Address - Street 1:1001 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2939
Practice Address - Country:US
Practice Address - Phone:985-649-8767
Practice Address - Fax:985-649-8838
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2020-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA300960207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology