Provider Demographics
| NPI: | 1386616571 |
|---|---|
| Name: | FEBRY, RICARDO (MD) |
| Entity type: | Individual |
| Prefix: | DR |
| First Name: | RICARDO |
| Middle Name: | |
| Last Name: | FEBRY |
| 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: | 3941 HOUMA BLVD STE 1A |
| Mailing Address - Street 2: | |
| Mailing Address - City: | METAIRIE |
| Mailing Address - State: | LA |
| Mailing Address - Zip Code: | 70006-2920 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 504-457-2200 |
| Mailing Address - Fax: | 504-457-2207 |
| Practice Address - Street 1: | 3941 HOUMA BLVD STE 1A |
| Practice Address - Street 2: | |
| Practice Address - City: | METAIRIE |
| Practice Address - State: | LA |
| Practice Address - Zip Code: | 70006-2920 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 504-457-2200 |
| Practice Address - Fax: | 504-457-2207 |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2006-02-02 |
| Last Update Date: | 2023-07-06 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| LA | 09228R | 207R00000X |
| LA | MD.09228R | 207RH0002X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 207RH0002X | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| LA | 1962899 | Medicaid | |
| LA | 1962899 | Medicaid | |
| LA | 5R605 | Medicare PIN |