Provider Demographics
NPI:1821199696
Name:MICHEL, RICHARD ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROY
Last Name:MICHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:R
Other - Last Name:MICHEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:110 LA RUE MEDECINE ST
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2637
Mailing Address - Country:US
Mailing Address - Phone:318-253-6564
Mailing Address - Fax:318-253-8256
Practice Address - Street 1:110 LA RUE MEDECINE ST
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2637
Practice Address - Country:US
Practice Address - Phone:318-253-6564
Practice Address - Fax:318-253-8256
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7941208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB64657Medicare UPIN