Provider Demographics
NPI:1942202536
Name:RICHERT, ALLEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:C
Last Name:RICHERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-3425
Mailing Address - Country:US
Mailing Address - Phone:337-527-6301
Mailing Address - Fax:337-527-9194
Practice Address - Street 1:920 1ST AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-3425
Practice Address - Country:US
Practice Address - Phone:337-527-6301
Practice Address - Fax:337-527-9194
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1121185Medicaid
LAB65447Medicare UPIN
LA1121185Medicaid