Provider Demographics
NPI:1922075803
Name:ROVIRA, KLAR ANTONIA IV (MD)
Entity Type:Individual
Prefix:DR
First Name:KLAR
Middle Name:ANTONIA
Last Name:ROVIRA
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2710
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-2710
Mailing Address - Country:US
Mailing Address - Phone:985-646-0691
Mailing Address - Fax:985-646-0750
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:985-646-0691
Practice Address - Fax:985-646-0750
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10064R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119940Medicaid
LA1497797Medicaid
LA1497797Medicaid
MS00119940Medicaid