Provider Demographics
NPI:1699024901
Name:DR ROBERT ADAM BROCATO LLC
Entity Type:Organization
Organization Name:DR ROBERT ADAM BROCATO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:BROCATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-256-5691
Mailing Address - Street 1:PO BOX 2673
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-2673
Mailing Address - Country:US
Mailing Address - Phone:800-684-0052
Mailing Address - Fax:
Practice Address - Street 1:240 HIGHLAND DRIVE
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3718
Practice Address - Country:US
Practice Address - Phone:318-256-5691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1052400Medicaid
LA1052400Medicaid