Provider Demographics
NPI:1659345502
Name:MARCANTEL, ROBBIE BOYD (PAC)
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:BOYD
Last Name:MARCANTEL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2780
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-2780
Mailing Address - Country:US
Mailing Address - Phone:318-992-9200
Mailing Address - Fax:318-992-9280
Practice Address - Street 1:180 NINTH ST
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-3900
Practice Address - Country:US
Practice Address - Phone:318-992-9268
Practice Address - Fax:318-992-6201
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPAA10386RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP000014188OtherRAILROAD MEDICARE PALMETT
P78561Medicare UPIN
LA5F735P469Medicare ID - Type Unspecified