Provider Demographics
NPI:1972506095
Name:KENNY, ROBERT TRAVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TRAVIS
Last Name:KENNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3225 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6203
Mailing Address - Country:US
Mailing Address - Phone:504-821-9444
Mailing Address - Fax:504-821-9446
Practice Address - Street 1:3225 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6203
Practice Address - Country:US
Practice Address - Phone:504-821-9444
Practice Address - Fax:504-821-9446
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA6414207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1142921Medicaid
LA52881Medicare ID - Type Unspecified