Provider Demographics
NPI:1942523675
Name:ROBERT P BLEREAU LTD
Entity Type:Organization
Organization Name:ROBERT P BLEREAU LTD
Other - Org Name:ROBERT BLEREAU MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-385-3000
Mailing Address - Street 1:1122 EIGHTH ST
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1987
Mailing Address - Country:US
Mailing Address - Phone:985-385-3000
Mailing Address - Fax:985-385-3002
Practice Address - Street 1:1122 EIGHTH ST
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1987
Practice Address - Country:US
Practice Address - Phone:985-385-3000
Practice Address - Fax:985-385-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009089261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1083828Medicaid
LA1083828Medicaid