Provider Demographics
NPI:1679865562
Name:STOBER, KIERAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:KIERAN
Middle Name:C
Last Name:STOBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KC
Other - Middle Name:
Other - Last Name:STOBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1101 MEDICAL CENTER BLVD.
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-349-1656
Mailing Address - Fax:504-349-1933
Practice Address - Street 1:4513 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3120
Practice Address - Country:US
Practice Address - Phone:504-349-6360
Practice Address - Fax:504-349-6363
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207339207R00000X
LAMD.207339207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine